【作者】 杨立新；

【导师】 张海峰；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 膀胱癌是我国泌尿外科最常见的肿瘤,占全部恶性肿瘤的3.2%,其中尿路上皮癌占95%以上。膀胱癌生物学行为复杂,具有好多发、易复发的特点,随着肿瘤复发,膀胱癌具有低分化和浸润性生长的倾向。其生物学特征及其临床发展过程并未完全明了。抑癌基因p53所编码的核蛋白,通过调节细胞的增殖周期,诱导DNA受损的细胞凋亡而起到抑癌作用。p53基因易发生突变,其变异的蛋白将失去抑癌作用。Ki-67即细胞核相关抗原(nuclear-associated antigen ki-67)是一种与细胞增殖密切相关的核抗原,在增殖细胞中表达,而在静止细胞中则不表达,Ki-67的异常表达反映了肿瘤细胞的增殖活性。Ki-67是反映癌细胞增殖能力的较好指标。本文查阅2005年3月~2007年12月份膀胱癌患者住院病历,术前未经过化疗、免疫、放射治疗,术后行免疫组化检测p53、Ki-67表达情况,共计149例,患者病历资料完整。统计结果显示p53及Ki-67的表达与膀胱癌的病理分级、临床分期呈正相关, P53、Ki-63共同表达阳性组复发率较单一阳性或阴性组复发率高(P<0.01),说明p53和Ki-67联合表达是判断肿瘤复发更可靠的指标。由此推论通过检测p53、Ki-67在膀胱癌中的表达情况,分析其与膀胱癌的发生、发展的关系,可以判断膀胱癌的恶性程度、预后估计及指导临床术后辅助治疗方案的制定。更多还原

【Abstract】 Objective: To explore the relationship between the expression of p53 and Ki-67 and patterns, grades and stages of the bladder carcinoma, and evaluate correlation of p53, Ki-67 expression and the bladder carcinoma. Through the expression of P53 and Ki-67, we could judge the prognosis of bladder carcinoma and guide the clinical treatment correctly.Methods: We collected clinical information of 149 patients with bladder carcinoma treated from March 2005 to December 2007 in the urology department of first Hospital in Jilin University. The collected information included: sexuality, age, preoperative status, clinical stage, operative method, postoperative irrigation method, pathologic grade, p53 expression (>20% was positive), Ki-67 expression (>20% was positive). We followed up patients through out-patient clinic and telephone, and the follow-up period was from three months to two years after operation.Results:1. We collected 149 cases. 114 were male and 35 were female. The ages were from 28 to 90, and the mid-age was 66 years old. Pathologic grade: I was 4, and II was 115, and III was 30 cases. Clinical stage: Ta-T1 (superficial pattern) was 84 and T2-T4 (invasive pattern) was 65 cases.2. P53 and Ki-67 gene expressions were not correlated with age, sexuality, the number and the size of tumors (P>0.05).3. Positive expressions in I-II grade tumors were 58.8% (P53) and 64.7% (Ki-67) respectively. The positive expressions in III grade tumor were 80.0% (p53) and 90.0% (Ki-67). The differences of the gene expression in two groups had statistical significance (P<0.05). Along with the advance of pathologic grades, the gene expression rates also increased.4. The expression rates in Ta-T1 (superficial type) tumors were 56.0% (p53) and 63.1% (Ki-67). The expression rates in T2-T4 (invasive type) tumors were 72.3% (p53) and 78.3% (Ki-67). The expressions of p53 and Ki-67 in invasive type bladder carcinoma were both higher than the superficial type and the differences had statistical significance (P<0.05).5. The expression rate in the high-grade and advanced-stage group (66.7%; 58.5%) was higher than low-grade and early-stage group (42.0%; 38.1%). The difference had statistical significance (P<0.05).6. Follow-up: We followed up 128 cases of 149 cases. The follow-up rate was 86%. The case with bladder remained were 120, recurrence were in 31 cases, the recurrence rate was 25.8% (31/120). The recurrence rate of p53 and Ki-67 co-expression positive were 37.5% (21/56). The recurrence rate of the single positive expression and negative expression were 15.6% (10/64). The difference between the two groups were statistical significant (X2=7.46, P<0.01). Conclusion:1. The expression of p53 protein had a close relationship with clinical stages and pathologic grades of the bladder carcinoma. The overexpression of p53 in the bladder carcinoma suggests high malignancy and poor prognosis.2. The expression of Ki-67 protein increased with the advancement of clinical stages and pathologic grades. It can be one of the tumor markers that could evaluate the biological behavior of bladder carcinoma.3. The recurrence rate in the group of p53 and Ki-67 positive co-expression were higher than the group of single positive and negative. That suggests p53 and Ki-67 positive co-expression has a correlation with bladder carcinoma recurrence.4. Through detecting the expression of p53 and Ki-67 in bladder carcinoma, we could determine the malignant potent and prognosis of the cancer, and it also can help us to make the adjunctive therapy after operation.更多还原