Ki-67和P53的表达与原发性上尿路尿路上皮癌术后发生膀胱癌的关系

Relationship between expression of Ki-67 and P53 and intravesical recurrence in patients with primary upper tract urothelial carcinomas after radical nephroureterectomy

目的 研究肿瘤标记物Ki-67和P53在上尿路尿路上皮癌中的表达情况,结合传统临床病理参数分析原发性上尿路肿瘤根治术后发生膀胱癌的危险因素.方法 回顾性分析1 15例原发性上尿路肿瘤根治术后的临床病理资料.免疫组织化学检测肿瘤标记物Ki-67和P53蛋白在尿路上皮癌中的表达情况,联合传统临床病理参数多因素分析上尿路肿瘤术后发生膀胱癌的危险因素.结果 Ki-67在肿瘤标本中正常表达率44.87％ （48/107）,过表达率55.13％（59/107）.P53在肿瘤标本表达阴性率34.86％ （38/109）,弱阳性率25.69％ （28/109）,阳性率17.43％（19/109）,强阳性率22.02％ （24/109）.Ki-67和P53表达均与肿瘤分级有关（P =0.003）.原发性上尿路尿路上皮癌术后膀胱癌的发生率为11.30％（13/115）,平均随访时间为48.50个月（7～130个月）.多因素生存分析发现患病年龄＞65岁（P=0.040）,输尿管下段肿瘤（P =0.008）和Ki-67低表达（P=0.041）可作为膀胱癌出现的预测因素.结论 Ki-67正常表达可作为原发性上尿路尿路上皮癌术后发生膀胱癌的独立危险因素.

Objectives To investigate expression of biomarkers Ki-67 and P53 in primary upper tract urothelial carcinoma tissues.Combined with conventional cliniopathological parameters,their correlation with bladder tumor recurrence was analysised in patients with primary upper tract urothelial carcinomas after radical nephroureterectomy.Methods The data of 115 patients with primary upper tract urothelial carcinomas was collected and analyzed retrospectively.The expression of tumor markers Ki-67 and P53 protein were detected by immunohistochemistry.Combined with traditional cliniopathological factors and biomarkers,risk factors of bladder tumor recurrence were explored.Results Normal expression rate of Ki-67 was 44.87% （48/107）,and over-expression rate was 55.13% （59/107）.negative expression rate of P53 was 34.86% （38/109）,mild positive rate was 25.69% （28/109）,positive rate was 17.43% （19/109）,and strong positive rate was 22.02% （24/109）.Expressions of Ki-67 and P53 were both associated with tumor grade（P =0.003）.The incidence of bladder cancer was 11.30% （13/115） in patients with the primary upper tract urothelial carcinomas after radical nephroureterectomy,and the mean follow-up time was 48.50 months （7 ～ 130 months）.Prevalence age was more than 65 years by multivariate survival analysis（P =0.040）,ureteral tumors （P =0.008） and the low expression of Ki-67 （P =0.041） were independent predictors for bladder cancer.Conclusions Normal expression of Ki-67 can be an independent predictor for bladder tumor recurrence in primary upper tract urothelial carcinomas after radical nephroureterectomy.