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目的探讨膀胱移行细胞癌癌组织中耐药基因的表达及意义。方法应用免疫组化法检测65例膀胱移行细胞癌中耐药基因P-糖蛋白(P-gp)、谷胱甘肽-s-转移酶(GST-π)、拓扑异构酶Ⅱ(TOpoⅡ)、胸苷酸合成酶(TS)的表达,并分析其与临床病理特征及预后的关系。采用Cox比例风险模型对上述基因的表达与预后关系行单因素和多因素分析。结果P-gp阳性45例,定位于肿瘤细胞膜和细胞质,与肿瘤组织类型、UICC分期有关(P<0.05);TOpoⅡ阳性20例,定位于细胞核,与肿瘤浸润深度、淋巴结转移有关(P<0.05);GST-π阳性58例,定位于细胞质和细胞核,与各指标间均相关(P<0.05);TS阳性18例,定位于细胞质,与组织类型、淋巴结转移、UICC分期有关(P<0.05)。多因素Cox比例风险模型分析示TOPOⅡ、GST-π表达与膀胱移行细胞癌患者预后有关(P<0.05)。结论膀胱移行细胞癌中耐药基因表达水平对化疗药物的选择有指导意义;TOpoⅡ、GST-π可作为判断膀胱移行细胞癌患者预后的指标。
Objective To investigate the expression and significance of drug resistance genes in bladder transitional cell carcinoma. Methods The expressions of P-glycoprotein, GST-π, TOpoⅡ in 65 cases of bladder transitional cell carcinoma were detected by immunohistochemistry. , Thymidylate synthase (TS) expression, and analyze its relationship with clinicopathological features and prognosis. The Cox proportional hazards model was used to analyze the relationship between the above gene expression and prognosis by single factor and multivariate analysis. Results P-gp was positive in 45 cases and localized in tumor cell membrane and cytoplasm, which was related to tumor type and UICC stage (P <0.05). Twenty PO-Ⅱ positive tumors were located in the nucleus and were associated with tumor infiltration depth and lymph node metastasis ). There were 58 positive cases of GST-π localized in the cytoplasm and nucleus, all of them were correlated with each index (P <0.05). The positive expression of TS was localized in the cytoplasm and was associated with the histological type, lymph node metastasis and UICC staging ). Multivariate Cox proportional hazards model analysis showed TOPO Ⅱ, GST-π expression in bladder transitional cell carcinoma patients with prognosis (P <0.05). Conclusions The expression of drug resistance genes in transitional cell carcinoma of the bladder may be instructive for the choice of chemotherapeutic agents. TOpo Ⅱ and GST-π may be used as prognostic indicators in patients with transitional cell carcinoma of the bladder.