膀胱移行细胞癌组织中p53和血管内皮生长因子表达的关系及临床意义

目的研究p53和血管内皮生长因子（VEGF）在膀胱移行细胞癌（BTCC）组织中的表达及与BTCC临床参数的关系。方法免疫组织化学LDP法检测86例BTCC组织及10例正常膀胱组织中p53蛋白及VEGF的表达。BTCC病理分级（WHO）：G126例，G248例，G312例；临床分期（UICC）：浅表性66例，浸润性20例；随访10个月一8年，复发30例。结果BTCC组织中p53与VEGF阳性表达率分别为46．5％（40／86）和66．3％（57／86）。正常膀胱组织p53及VEGF均无表达。p53表达与VEGF表达呈明显正相关（P〈0．05）；二者均与BTCC的组织学分级显著相关（P〈0．05）；浸润性肿瘤阳性表达率明显高于浅表性肿瘤（P〈0．01）。p53阳性和VEGF阳性表达的肿瘤复发迅速，p53阴性而VEGF阳性表达较阴性表达者预后差。结论p53和VEGF与BTCC组织学分级和预后密切相关。BTCC是典型的血管依赖性病变，p53可能通过p53-VEGF调节旁路途径促进BTCC的肿瘤血管形成，联合检测p53和VEGF的表达可作为判断BTCC生物学行为及预后的重要指标。

The expression of p53 and VEGF in bladder transitional cell carcinoma and its clinical significance

Objective To study the expression of p53 and vascular endothelial growth factor(VEGF) in bladder transitional cell carcinoma(BTCC) tissue and its relationship with the clinicopathologic parameters,and to understand the role of p53 and VEGF in the progression of tumors.Methods The expression of p53 and VEGF in 86 cases of BTCC were determined by immunohistochemical LDP methods.Results The positive expression rates of p53 and VEGF in 86 cases of BTCC were 46.51% and 66.28%,respectively.The positive correlation was noted between p53 expression and VEGF expression(P<0.05);and both of them were significantly related to the tumor pathologic grades(P<0.05),the invasiveness of the tumor tissues(P<0.01) and the recurrence time of tumor(P<0.05).Tumors with high VEGF expression that was positive for p53 recurred earlier and had a greater risk of stage progression than did those with low VEGF expression and p53 negative tumors.The high level of VEGF also indicated the poorer prognosis in p53 negative tumors than did those of low VEGF tumors.Conclusions This study indicates that p53 and VEGF are closely correlated with the histopathological grades and prognosis of BTCC.The pathological changes in the tumor are typically vessel dependent,and vascularization is favorable to tumor growth,infiltration and recurrence.Mutant-type p53 protein accumulation may be associated with tumor angiogenesis through the way of VEGF up-regulation.The combined detection of p53 and VEGF may serve as an important index to estimate the biological behavior and prognosis of BTCC.