摘要
目的研究膀胱尿路上皮癌发生淋巴结微转移(LNM)的概率和影响因素,并分析LNM和5年生存率的关系。方法纳入PT1-4N0M0膀胱尿路上皮癌患者128例,均行根治性全膀胱切除术,术后随访7～112个月。应用免疫组化SP法观察尿溶蛋白Ⅱ(UPⅡ)和细胞角蛋白20(CK20)在手术清扫淋巴结中的表达情况,分析相关临床和病理因素与UPⅡ、CK20表达的关系,并对发生LNM(UPⅡ和CK20表达阳性)患者与未发生LNM患者5年生存率的差异进行统计分析。结果 128例患者中,39例(30.47%)患者的淋巴结中找到阳性表达的肿瘤细胞,证实发生LNM。25例患者经UPⅡ抗体检测出现LNM,发生率为19.53%(25/128),CK20抗体检测24例患者出现LNM,发生率为18.75%(24/128),两者联合检测可提高LNM检出率(P<0.05)。LNM与肿瘤的病理分期、分级相关(P<0.05),但与患者的年龄、性别及肿瘤大小和数目无关。出现LNM的患者与未出现LNM患者的术后5年生存率分别为41.03%、68.54%,两者比较差异有统计学意义(P<0.01)。结论使用UPⅡ和CK20联合免疫组化检测膀胱癌淋巴结可提高LNM的检出率。高分期与高分级的膀胱癌容易发生LNM,发生LNM的患者预后相对较差。
Objective To evaluate the probability and impact factors of lymph node micrometastasis（LNM） in patients with bladder urothelial cancer（ PT1-4N0M0 ） , and investigate the relationship between LNM and 5-year survival rate. Methods 128 bladder cancer patients who had been followed up for 7 to 112 months afier radical cystectomy were enrolled. The expression of Uroplakin Ⅲ（UP Ⅱ ） and Cytokeratin20（CK20） were examined in lymph nodes by SP immunohistochemistry after surgical lymphadenectomy. The relationship between clinical parameters, pathologic parameters, UP Ⅱ and CK20 expression was analyzed. The difference of g-year survival rates between patients with or without LNM was statistically analyzed. Results 39 of 128 cases showing positive stained lymph nodes were difinifaly diagnosed as LNM. Immunohistochemical analysis of 25 cases was positive for UP Ⅱ , and immunohistochemical analysis of 24 cases was positive for CK20. Combined method with UP Ⅱ and CK20 can enhance the detection rate of LNM. LNM of bladder cancer was statistically associated with pathological staging and grade （P 〈 0.05） rather than patients＇ age, gender and tumor size and number. The 5-year survival rates in patients with or without LNM were 41.03% and 68.54% , the difference was statistically significant（P 〈0.01 ）. Conclusion hnmunohistochemical method combined with UP Ⅱ and CK20 can enhance the detection rate of LNM for bladder cancer. Patients withing high tumor staging（T3-4 ） or grading （G3 ）are suscceptible to LNM. The patients with LNM always have a poor prognosis.
出处
《安徽医科大学学报》
CAS
北大核心
2013年第5期516-519,共4页
Acta Universitatis Medicinalis Anhui
