乳腺丝氨酸抑制蛋白在膀胱癌组织中的表达及其与淋巴结转移的关系

Expression of Maspin in bladder carcinoma and the relationship between Maspin and lymph node metastasis

目的:检测膀胱癌组织中乳腺丝氨酸抑制蛋白(mammary serine protease inhibitor,Maspin)的表达,探讨Maspin与临床病理及其与淋巴结转移的关系。方法:采用免疫组织化学染色的方法检测72例膀胱癌组织和12例正常膀胱黏膜组织的Maspin表达;分析72例膀胱癌患者术前盆腔CT扫描图片以及术后患者淋巴结标本的病理资料,计算诊断标准的敏感性、特异性、阳性预测值、阴性预测值,比较分析Maspin检测、螺旋CT在术前诊断膀胱癌是否有淋巴结转移方面的诊断效果。结果:1)膀胱癌组织的Maspin阳性表达显著低于正常膀胱黏膜组织(P<0.05);2)Maspin蛋白的表达随着临床分期、病理分级的增高以及淋巴结转移阳性而显著下调(均P<0.05);3)27例患者CT诊断出有盆腔淋巴结转移,淋巴结转移阳性率为37.5%(27/72);病理结果显示72例膀胱癌患者中有22例发生淋巴结转移,淋巴结转移阳性率为30.5%(22/72),以病理检查的结果作为淋巴结转移的金标准,计算出72例患者通过CT检查诊断淋巴结转移阳性的灵敏度、特异度、阳性预测值、阴性预测值分别为45.5%,73.3%,37.0%和66.7%;通过免疫组织化学检测膀胱癌组织中Maspin蛋白表达的淋巴结转移阳性的灵敏度、特异度、阳性预测值和阴性预测值分别为81.8%,50%,41.8%和86.2%。最后将盆腔CT扫描联合免疫组织化学检测Maspin蛋白表达共同诊断淋巴结转移的灵敏度为90.9%,特异度为78.0%,阳性预测值为64.5%,阴性预测值为95.0%。结论:Maspin在膀胱癌组织中的表达较正常膀胱组织显著下调;Maspin的下调与淋巴结转移关系密切;Maspin在诊断膀胱癌患者淋巴结转移中也许是一个有价值的肿瘤生物标志物,通过检测膀胱癌组织中Maspin的表达联合盆腔CT扫描共同评估膀胱癌患者中淋巴结是否转移的情况,比单独用CT扫描或者Maspin表达可能具有更大的潜力和优势。

Objective:To examine the expression of Maspin in the bladder carcinoma,and to explore the relationship among Maspin expression,clinical pathology and lymph node metastasis.Methods:The expression of Maspin in 72 bladder cancer tissues and 12 normal bladder tissues were detected by immunohistochemistry.Preoperative pelvic CT images and postoperative pathological results of lymph node metastasis in 72 bladder cancer patients were analyzed retrospectively.The sensibility,specificity,positive predictive value and negative predictive value were calculated,and the advantage for diagnosis of lymph node metastasis was compared between Maspin examination and CT scan.Results:1) The expression of Maspin in 72 bladder cancer tissues was significantly lower than that in the normal bladder tissues(P<0.05);2) The expression of Maspin was obviously decreased with the progress in clinical stage,pathlogical grade and lymph node metastasis,with significant difference(all P<0.05);3) There were 27 patients diagnosed as pelvic lymph node metastasis by CT scan,and the positive rate was 37.5%(27/72);there were 22 patients diagnosed as pelvic lymph node metastasis by pathological results,and the positive rate was 30.5%(22/72).The pathological diagnose for pelvic lymph node metastasis was the gold standard.The sensitivity,specificity,positive predictive value and negative predictive value for CT was 45.5%,73.3%,37.0%,and 66.7%,respectively;the sensibility,specificity,positive predictive value and negative predictive value was81.8%,50%,41.8%and 86.2%in the diagnosis of lymph node metastasis for the 72 bladder cancer cases by Maspin examination;the sensitivity,specificity,positive predictive value and negative predictive was 90.9%,78.0%,64.5%and 95.0%in the diagnose of lymph node metastasis by Maspin examination combined with CT scan.Conclusion:The expression of Maspin in bladder cancer is significantly lower than that in normal bladder cancer,and a statistically significant correlation is also observed between Maspin expression and lymph node metastasis.Maspin maybe a valuable biomarker in diagnose of bladder cancer with lymph node metastasis.Maspin examination combined with CT scan has more advantage in the evaluation of bladder cancer with lymph node metastasis than Maspin or CT alone.