CAJ | 학술논문

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。
목적：탐토착배수복기인hMSH2재방광이행세포암중적표체정황여종류예후적관계。방법회고성연구101례방광이행세포암환자적림상자료，채용면역조직화학법검측착배수복기인hMSH2적표체정황，통과문진복사、서신혹전화련계방식대환자진행수방，수방12～72월，평균49월。수거분석채용SPSS 21．0통계연건，생존분석응용Kaplan-M eier법，생존솔비교채용Log-rank검험，다인소분석채용Cox비례풍험회귀모형。결과31례（31/101，30．7％）침윤성방광이행세포암환자중，22례hMSH2위（＋）표체，9례（9/101，8．9％）완전（-）표체；70례（70/101，69．3％）천표성방광이행세포암위（촉혹처）표체。수방결속시공56례복발，총복발솔위55．45％。단인소분석발현，hMSH2저표체조평균무복발생존시간（57．20월）교고표체조（40．08월）장（P＜0．05）。이방광이행세포암적TNM분기、조직학분급、림파결전이여종류복발역밀절상관（P＜0．05）；Cox비례풍험모형다인소분석발현，부 TNM 분기급 hMSH2표체정황진입COX회귀모형。결론착배수복기인hMSH2표체가능시방광이행세포암독립예후지표，여종류복발긴밀상관，hMSH2저표체조여상동분기적고표체조비교，복발가능성소。
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 .