p53基因突变与老年人膀胱癌预后关系的研究

p53 gene mutation and prognosis of the urinary bladder tumors of the elderly

目的 探讨老年人膀胱癌组织 ｐ５３ 基因突变与临床分期、病理分级及预后的关系。方法 利用 Ｐ Ｃ Ｒ Ｓ Ｓ Ｃ Ｐ 及 Ｐ Ｃ Ｒ 直接循环测序技术，分析 ７０ 例 ６０ 岁以上老年人膀胱癌组织 ｐ５３ 基因突变。结果 ７０ 例中 ２４ 例（３４３％ ）发生 ｐ５３ 基因突变。侵润性 膀胱癌（ｐ Ｔ２ ～ｐ Ｔ ４ ）组比浅表性性膀胱癌（ｐ Ｔ ａ～ｐ Ｔ１ ）组、Ⅱ～Ⅲ级组比Ⅰ级组 ｐ５３ 基因突变率明显增高（ Ｐ ＝ ００２０ 和 Ｐ ＝００２３）。突变阳性组与突变阴性组的 １ 年、３ 年、５ 年生存率分别为 ６３６％ 、４０１％ 、４０１％ 及 ９１８％ 、７６４％ 、５６４％ ，阳性组较阴性组明显预后不良（ Ｐ＝ ００２３）。结论 ｐ５３ 基因突变可作为预测老年人膀胱癌恶性进展及鉴别浸润性与浅表性膀胱癌、预后判断有用的分子生物学指标。

To investigate the connection for the p53 gene mutation and stage, grade and prognosis in urinary bladder tumors of the elderly, polymerase chain reaction single strand conformation polymorphism(PCR SSCP) and PCR direct cycle sequence was performed for analysis from exon 5 to 8 of p53 gene in 70 elderly cases of urinary bladder tumors. A significant differences were found for groups with stage pTa to pT1 and pT2 to pT4 (P=0 020) tumors, grades Ⅰ and grades Ⅱ to Ⅲ (P=0 023) cancer, and survival rates of 1, 3 and 5 years were observed 63.6%, 40.1%, 40.1% and 91.8%, 76.4%,56.4%, respectively (P=0 023) , in case of with and without p53 gene mutations. These results suggest mutation of p53 gene may be possibly useful as molecular markers for discriminate the muscle invasive(pT2 4) and superficial tumors, evolvement and prognosis of urinary bladder tumors of the elderly.