CK20和CK5免疫组化结果作为上尿路上皮癌分子识别标记及在评估患者预后中的作用

目的探讨CK20和CK5在上尿路上皮癌(UTUC)患者组织中的表达情况,分析其与患者临床病理特点的关系及其预测预后的价值。方法选取2013年7月至2017年7月在榆林市第一医院泌尿外科住院治疗的UTUC患者106例,采用免疫组化(IHC)法检测UTUC患者组织中CK20和CK5的表达情况。分析CK20、CK5与UTUC患者临床病理特点之间的关系;采用Kaplan-Meier生存曲线分析UTUC患者术后生存情况;Cox比例风险回归模型分析CK20和CK5对UTUC患者预后的影响。结果106例患者中CK20(+)/CK5(+)组患者pTa/pT1比例及低级别比例显著高于CK20(-)/CK5(+)组、CK20(+)/CK5(-)组和CK20(-)/CK5(-)组(P<0.05)。免疫组化结果表明CK5和CK20均阳性表达于细胞质,在上皮癌组织中的表达显著高于正常尿路上皮组织(P<0.05)。CK20(+)/CK5(-)组患者2、4、6年期生存率均显著低于其他3组,差异有统计学意义(P<0.05)。Cox比例风险回归模型分析显示CK20(+)/CK5(-)、肿瘤分期、微转移是影响UTUC患者预后的重要危险因素。结论CK20和CK5均是评估UTUC预后的独立分子标记物,当CK20(+)、CK5(-)时,患者术后生存情况较差、易发生转移,可作为评价UTUC患者预后的重要指标。

CK20 and CK5 immunohistochemical subtyping in identification of upper tract urothelial carcinoma and the prognostic value

Objective To investigate the expressions of CK20 and CK5 in upper tract urothelial carcinoma(UTUC),and analyze their relationship with the clinicopathological characteristics of UTUC and prognosis.Methods The clinical data of 106 UTUC patients hospitalized in our hospital during Jul.2013 and Jul.2017 were reviewed.The expressions of CK20 and CK5 were detected with immunohistochemistry.The relationship between CK20 and CK5 expressions and the clinicopathological characteristics of UTUC was analyzed.The patients survival was analyzed with Kaplan-Meier survival curve.The effects of CK20 and CK5 on prognosis was analyzed with Cox proportional hazard regression model.Results The CK20(+)/CK5(+)group had significantly higher pTa/pT1 ratio and low pTa/pT1 ratio than CK20(-)/CK5(+)group,CK20(+)/CK5(-)group and CK20(-)/CK5(-)group(P<0.05).Immunohistochemistry showed that both CK5 and CK20 were positively expressed in the cytoplasm,and CK5 and CK20 expression were higher in epithelial carcinoma tissues than in normal urothelial epithelial tissues(P<0.05).The CK20(+)/CK5(-)group had significantly lower 2-,4-and 6-year survival rates than the other 3 groups(P<0.05).Cox proportional hazard regression model showed that CK20(+)/CK5(-),tumor stage and micrometastasis were important factors affecting the prognosis of UTUC patients.Conclusion CK20 and CK5 are independent molecular markers to evaluate the prognosis of UTUC.Patients with positive CK20 but negative CK5 have poor survival and are prone to metastasis.CK20 and CK5 expressions can be used as important indicators for the prognosis.