膀胱尿路上皮癌组织中N-钙黏附素蛋白表达与预后关系的研究

Expression of N-cadherin protein in urothelial bladder cancer and its relation to prognosis

目的 探讨膀胱癌组织中N-钙黏附素蛋白表达与临床病理特征及预后的关系.方法 采用免疫组化方法检测2003年1月至2012年4月145例膀胱尿路上皮癌组织及25例正常膀胱组织中N-钙黏附素蛋白的表达情况.145例膀胱尿路上皮癌患者中,男104例,女41例.年龄49～83岁,中位年龄70岁,其中≤65岁57例,＞65岁88例.肿瘤大小≤3 cm 79例,＞3 cm 66例.肿瘤单发86例,多发59例.病理分级G1级44例,G2～G3级101例;分期（AJCC2002标准）Ta～T1期94例,T2～T4期51例.分析N-钙黏附素蛋白表达与膀胱癌分级、分期、数目、大小、预后及患者年龄、性别的关系. 结果 145例膀胱癌组织中N-钙黏附素蛋白表达阳性率为54.2％（76/145）,正常组织中N-钙黏附素蛋白表达阳性率为12.0％（3/25）,两组间差异有统计学意义（P＜0.01）.G1级和G2～ G3级别膀胱癌中N-钙黏附素蛋白表达阳性率分别为38.6％ （17/44）、58.4％（59/101）,差异有统计学意义（P=0.028）.非肌层浸润性癌和肌层浸润性癌组织中N-钙黏附素蛋白表达阳性率分别为45.7％（43/94）和64.7％（33/51）,差异有统计学意义（P=0.029）.N-钙黏附素蛋白表达与患者年龄、性别、肿瘤的大小及数目无明显相关性（P＞0.05）.肌层浸润性癌患者随访4～103个月,平均42.5个月,N-钙黏附素蛋白阳性表达患者总生存率24.2％ （8/33）,N-钙黏附素蛋白阴性表达患者总生存率66.7％（12/18）,Kaplan-Meier生存分析显示,两组间总生存率差异有统计学意义（P=0.002 2）.多因素Cox回归分析显示N-钙黏附素蛋白表达是膀胱癌预后的重要因素. 结论 N-钙黏附素蛋白表达在膀胱癌组织中明显高于正常组织,N-钙黏附素蛋白的检测有助于膀胱癌的诊断及预后评估.

Objective To explore the expression and significance of N-cadherin in urothelial bladder cancer and analyse its relation to clinicpathologic and prognosis of bladder cancer.Methods The expression of N-cadherin in 145 urothelial bladder cancer and 25 normal bladder tissues was detected by immunuhistochemisty,and correlations between N-cadherin and clinicopathologic features were analysed.Results The positive rate of N-cadherin protein was significantly higher in bladder cancer than in normal bladder tissue （P〈0.01）.The positive rate of N-cadherin protein was 38.6% in G1 bladder cancer,58.4% in G2-G3 bladder cancer,and its difference was significant （P =0.028）.The expression was significantly lower in non-muscle-invasive bladder cancer than in muscle invasive bladder cancer （45.7% vs 64.7%,P=0.029）.The muscle-invasive bladder cancer patients were followed up 4-103 months.Among those,the overall survival with positive expression of N-cadherin protein was 24.2% （8/33）,and the overall survival with negative expression of N-cadherin protein was 66.7 % （12/18）.Kaplan-Meier analysis showed the positive expression of N-cadherin was significantly associated with overall survival of patients with muscle-invasive-bladder cancer （P=0.002 2）.Multivariate Cox analysis showed that N-cadherin expression was an important prognostic factor.Conclusions The expression of N-cadherin protein was high in bladder cancer.The detection of the expression of N-cadherin protein is associated with the diagnosis and prognosis of bladder cancer.