错配修复基因hMSH2表达与膀胱移行细胞癌预后关系的研究

目的：探讨错配修复基因hMSH2在膀胱移行细胞癌中的表达情况与肿瘤预后的关系。方法回顾性研究101例膀胱移行细胞癌患者的临床资料，采用免疫组织化学法检测错配修复基因hMSH2的表达情况，通过门诊复查、书信或电话联系方式对患者进行随访，随访12～72月，平均49月。数据分析采用SPSS 21．0统计软件，生存分析应用Kaplan-M eier法，生存率比较采用Log-rank检验，多因素分析采用Cox比例风险回归模型。结果31例（31/101，30．7％）浸润性膀胱移行细胞癌患者中，22例hMSH2为（＋）表达，9例（9/101，8．9％）完全（-）表达；70例（70/101，69．3％）浅表性膀胱移行细胞癌为（触或处）表达。随访结束时共56例复发，总复发率为55．45％。单因素分析发现，hMSH2低表达组平均无复发生存时间（57．20月）较高表达组（40．08月）长（P＜0．05）。而膀胱移行细胞癌的TNM分期、组织学分级、淋巴结转移与肿瘤复发亦密切相关（P＜0．05）；Cox比例风险模型多因素分析发现，仅 TNM 分期及 hMSH2表达情况进入COX回归模型。结论错配修复基因hMSH2表达可能是膀胱移行细胞癌独立预后指标，与肿瘤复发紧密相关，hMSH2低表达组与相同分期的高表达组比较，复发可能性小。

Relationship between the Expression of hMSH2 and Prognosis in Patients with Bladder Transitional Cell Carcinoma

Objective To investigate the expression patterns of hMSH2 in human bladder transi-tional cell carcinoma and to assess the correlation of hMSH 2 protein to prognosis of the patients . Meth-ods 101 bladder cancer patients at the First Affiliated Hospital of Fujian Medical University between 1999 to 2012 were investigated retrospectively ,we examined the expression patterns of hMSH2 by immunohis-tochemical technique ,followed the patients for a median time of 49 months（range 12~72 months） by out-patient review ,mail ,or telephone . The survival rate was calculated by the Kaplan-Meier method ,the log-rank test and Cox＇s proportional hazards regression model using SPSS 21 .0 . Results Staining inten-sity of hMSH2 was as follows ：weak staining in 22/101（21 .8% ） ,negative in 9/101 （8 .9% ） samples ,mod-erate or strong staining in 70/101 （69 .3% ） samples .56/101（55 .45% ） was found recurrence when the fol-low-up ended . Univariate survival analysis showed the average recurrence-free survival of patients whose tumous with reduced and preserved for hMSH2 was 40 .08 and 57 .20 months ,respectively ,with the difference being statistically significant in univariate analysis （χ2 =5 .798 , P=0 .016） ,indicated that prog-nosis of patients with TCC was significantly corrected with pathological stage ,histological grade ,lymph code metastasis ,as well as expression of hMSH2 （P〈0 .05） . Cox proportional hazards model multivari-ate survival analysis showed that TNM stage and expression of hMSH 2 can be independent indicator for re-lapse of TCC . Conclusion hMSH2 expression may have a potential role as prognostic indicator ,reduced hMSH2 expression is associated with tumors of advanced stage and grade ,a favorable clinical outcome ap-pears present when compared to those similar staged tumors with normal hMSH 2 expression .