乏氧状态对膀胱癌全膀胱切除术后患者预后的影响

Effect of hypoxia on postoperative prognosis of radical cystectomy in patients with bladder cancer

目的探讨机体乏氧状态对膀胱癌全膀胱切除术后患者预后的影响。方法 66例膀胱尿路上皮癌行全膀胱切除手术患者,分为机体乏氧状态组(OH组,n=19)和机体常氧状态组(NS组,n=47)。免疫组化检测肿瘤组织缺氧诱导因子1α(HIF-1α)表达和CD105标记的肿瘤微血管密度(MVD)。随访术后生存时间,对比两组患者临床资料,Kaplan-Meier法分析两组生存率,建立Cox模型分析各变量与生存时间的相关性。结果 OH组肿瘤组织HIF-1α表达的阳性率为89.5%(17/19),MVD值为53.1±19.0,中位生存时间为56个月;NS组表达的阳性率为66.0%(31/47),MVD值为40.1±15.2,中位生存时间为82个月;两组临床分期、Hb水平、HIF-1α表达、MVD值间差异有统计学意义(P<0.05)。肿瘤分期高、机体乏氧、HIF-1α高表达和肿瘤高MVD值患者的生存期较短,而高Hb患者的生存期延长(P<0.05或P<0.01)。结论机体乏氧状态下的膀胱癌组织HIF-1α表达上升,肿瘤微血管密度增加,不利于患者预后。

Objective To explore the effect of hypoxia on postoperative prognosis of radical cystectomy in patients with bladder cancer. Methods A total of 66 patients with bladder urothelial cancer undergoing radical cystectomy surgery were divided into hypoxia group （OH group, n=19） and the normoxic group （NS group, n=47）. Immunohistochemical examination was used to examine the expression of HIF-1α and CD105-assessed microvessel density （MVD）. The survival of the patients was followed up and the clinical data of the two groups were compared. Kaplan-Meier analysis was used for analyzing the survival of the two groups, and a Cox model was established to analyze correlation of each variable with the survival time. Results In the OH group, the positive rate of HIF-1α was 89.5% （17/19） in the tumor tissues, the MVD value was 53.1±19.0, and the median survival time was 56 months; the corresponding values in the NS group were 66.0% （31/47）, 40.1±15.2, and 82 months, respectively. The clinical stages, Hb levels, HIF-1α expression, and MVD values were significantly different between the two groups （P〈0.05）. Advanced tumor stage, hypoxia state,high HIF-1α expression and high MVD value in tumor tissues were associated with a shorter survival of patients, and high Hb was associated with a longer survival of patients （P〈0.05 or P〈0.01）. Conclusion Hypoxic state can lead to increased HIF-1α expression and microvessel density in bladder cancer tissues, which is harmful for patient prognosis.