不同分子分型膀胱癌的临床特征及预后

目的：以膀胱癌细胞分裂周期相关因子3（CDCA3）基因分型为例，分析不同分子分型膀胱癌患者的临床特征及预后情况，为临床中治疗方案的制定提供参考。方法：以美国癌症基因组图谱（TCGA）数据库为基础，下载147份膀胱癌CDCA3基因表达谱和相关病例的资料信息，根据CDCA3表达水平由低到高排列，找出中位数，将低于中位数的样本设置为CDCA3低表达组（74例），将高于中位数的样本设置为CDCA3高表达组（73例），对比不同CDCA3基因型膀胱癌患者的临床特征和预后，并以基因集富集分析（GSEA）CDCA3在膀胱癌发生及发展中的作用及机制。结果：CDCA3高表达组肌层浸润患者比例、高级别T分期及N分期、肿瘤转移患者比例均高于CDCA3低表达组，而肿瘤分化程度低于CDCA3低表达组，差异均有统计学意义（P＜0.05）。CDCA3高表达组1年、3年复发率均高于CDCA3低表达组，差异均有统计学意义（P＜0.05）。CDCA3高表达组1年、3年生存率均低于CDCA3低表达组，差异均有统计学意义（P＜0.05）。GSEA发现CDCA3高表达膀胱癌细胞中富集了G2M检查点、糖酵解、E2F信号通路、MYC信号通路、MTOR信号通路、PTK通路、PI3K-AKT-mTOR信号通路、有丝分裂纺锤体、去折叠蛋白反应、胆固醇蛋白、精子发生等基因集。结论：CDCA3基因表达水平越低患者的肿瘤分期越低、肿瘤转移风险越小、分化程度越高，预后状况越好，复发率及死亡率也更低。CDCA3基因作用的发挥是通过调控多种基因通路实现的，CDCA3基因可能是潜在的膀胱癌生物标志物，可以通过分析其表达水平评估病情及预后，并展开针对性治疗。

Clinical characteristics and prognosis of different molecular classification bladder cancer

Objective: To analyze the clinical characteristics and prognosis of patients with different molecular classification bladder cancer by taking for example the classification of bladder cancer cell division cycle related factor 3 (CDCA3). Methods: Based on the American Cancer Genome Atlas (TCGA) database, 147 copies of bladder cancer CDCA3 gene expression profiles and related cases were downloaded. The CDCA3 expression levels were ranked from low to high to find the median. The samples were divided as CDCA3 low expression group (74 cases before the median) and CDCA3 high expression group (73 cases after the median). The clinical features and prognosis were compared between different CDCA3 genotype bladder cancer patients, and the mechanism of CDCA3 in the development and progression of bladder cancer was analyzed. Results: The proportion of patients with myometrial invasion, the stage of T stage and N stage, and the proportion of tumor metastasis in CDCA3 high expression group were higher than those in CDCA3 low expression group, and the tumor differentiation degree was lower than that in CDCA3 low expression group with significant difference (P<0.05). The recurrence rate of CDCA3 high expression group was higher than that of CDCA3 low expression group at 1 year and 3 years, with significant difference (P<0.05). The 1-year and 3-year survival rates of the CDCA3 high expression group were lower than those of the CDCA3 low expression group with significant difference (P<0.05).GSEA found that over-expressed CDCA3 bladder cancer cells were enriched with G2M checkpoints, glycolysis, E2F signaling pathway, MYC signaling pathway, MTOR signaling pathway, PTK pathway, PI3K-AKT-mTOR signaling pathway, mitotic spindle, unfolded protein Gene sets such as reaction, cholesterol protein, and spermatogenesis. Conclusion: The lower the CDCA3 gene expression level, the lower the tumor stage, the smaller the risk of tumor metastasis, the higher the degree of differentiation, the better the prognosis, and the lower the recurrence rate and mortality. The role of CDCA3 gene is achieved through the regulation of multiple gene pathways. CDCA3 gene may be a potential biomarker for bladder cancer, which can be evaluated by an analysis of its expression level and prognosis.