角蛋白7、p53蛋白与膀胱癌临床病理及预后的相关性

Correlation between keratin 7, p53 protein and clinicopathology and prognosis of bladder cancer

目的分析角蛋白7(KRT7)、p53蛋白与膀胱癌临床病理及预后的相关性。方法回顾性分析2016年2月—2019年3月江苏省连云港市第二人民医院病理科收治的膀胱癌患者105例的临床资料,患者均接受膀胱癌根治术,术中取癌组织与癌旁组织,采用免疫组化法检测癌组织与癌旁组织KRT7与p53蛋白表达水平,分析癌组织中KRT7蛋白、p53蛋白表达在不同临床病理特征中的差异,Cox分析膀胱癌患者预后的影响因素,Kaplan-Meier法分析KRT7蛋白、p53蛋白表达与膀胱癌患者预后的关系。结果癌组织KRT7蛋白阳性率低于癌旁组织(χ^(2)/P=23.786/<0.001),p53蛋白阳性率高于癌旁组织(χ^(2)/P=28.651/<0.001);T 2~T 4期低分化、肿瘤直径≥3 cm、患者癌组织中KRT7蛋白阳性率低于T a~T 1期中高分化、肿瘤直径<3 cm患者(χ^(2)/P=4.940/0.026、11.299/<0.001、5.379/0.020),p53蛋白阳性率显著高于T a~T 1期中高分化、肿瘤直径<3 cm患者(χ^(2)/P=22.459/<0.001、12.093/<0.001、25.527/<0.001);随访3年,105例膀胱癌患者失访4例,剩余101例患者中死亡34例,病死率为33.66%。Cox分析结果显示,T 2~T 4期、低分化、肿瘤直径≥3 cm、KRT7蛋白阴性、p53蛋白阳性为膀胱癌患者不良预后的危险因素[HR(95%CI)=3.935(1.730~8.952)、3.575(1.572~8.133)、3.515(1.545~7.996)、4.933(2.169~11.222)、3.762(1.654~8.558)]。KRT7蛋白阳性存活率高于KRT7蛋白阴性患者(χ^(2)=5.238,P=0.022);p53蛋白阴性存活率高于p53蛋白阳性患者(χ^(2)=5.115,P=0.024)。结论膀胱癌患者癌组织中KRT7、p53蛋白表达与分化程度、肿瘤直径、临床分期及预后密切相关。

Objective To analyze the correlation between keratin 7(KRT7),p53 protein and clinical pathology and prognosis of bladder cancer.Methods Retrospective analysis was made on the clinical data of 105 patients with bladder cancer admitted to the Pathology Department of the Second People's Hospital of Lianyungang City,Jiangsu Province from February 2016 to March 2019.All patients received radical surgery for bladder cancer.During the surgery,the cancerous tissues and adjacent tissues were taken,and the expression levels of KRT7 and p53 proteins in cancerous tissues and adjacent tissues were detected by immunohistochemical method,Cox was used to analyze the prognostic factors of bladder cancer patients,and Kaplan Meier method was used to analyze the relationship between KRT7 protein,p53 protein expression and the prognosis of bladder cancer patients.Results The positive rate of KRT7 protein in cancer tissue is lower than that in adjacent tissues(χ^(2)/P=23.786/<0.001),the positive rate of p53 protein is higher than that of adjacent tissues(χ^(2)/P=28.651/<0.001);Patients with poorly differentiated T2 to T4 stages,tumor diameter≥3 cm,and KRT7 protein positivity in cancer tissue are lower than those with moderately well differentiated Ta to T1 stages,and tumor diameter<3 cm(χ^(2)/P=4.940/0.026,11.299/<0.001,5.379/0.020),the positive rate of p53 protein is higher than that of patients with Ta-T1 stage,medium to high differentiation,and tumor diameter<3 cm(χ^(2)/P=22.459/<0.001,12.093/<0.001,25.527/<0.001);After 3 years of follow-up,4 of 105 bladder cancer patients lost the follow-up,and 34 of the remaining 101 patients died,with a case fatality rate of 33.66%.Cox analysis showed that T2~T4 stage,poor differentiation,tumor diameter≥3 cm,KRT7 protein negative and p53 protein positive were the risk factors for the prognosis of bladder cancer patients[HR(95%CI)=3.935(1.730-8.952),3.575(1.572-8.133),3.515(1.545-7.996),4.933(2.169-11.222),3.762(1.654-8.558)].The survival rate of KRT7 protein positive patients is higher than that of KRT7 protein negative patients(χ^(2)=5.238,P=0.022);The survival rate of p53 protein negative patients is higher than that of p53 protein positive patients(χ^(2)=5.115,P=0.024).Conclusion The expression of KRT7 and p53 protein in bladder cancer tissue is closely related to the degree of differentiation,tumor diameter,clinical stage and prognosis.