细胞角蛋白20 在膀胱癌中的研究进展

膀胱肿瘤是最常见的泌尿系统肿瘤,其中上皮性肿瘤占95%以上,绝大多数为尿路移行上皮细胞癌。膀胱癌的早期症状不 明显,复发率较高,早期诊断和治疗对提高其疗效非常重要。近年来,诊断膀胱肿瘤的新方法不断出现,显著提高了膀胱肿瘤诊断 及预后预测水平。其中,膀胱肿瘤标记物检测已成为膀胱肿瘤的诊断新方法,具有十分重要的临床意义。研究发现,细胞角蛋白20 (cytokeratin 20,CK20)是中间纤维家族成员之一,在正常膀胱组织中特异性表达于伞细胞,在膀胱癌中特异性表达于膀胱移行细 胞癌,其诊断膀胱肿瘤的特异性和灵敏性均较高,且与膀胱肿瘤的临床分级、病理分期和转移均密切相关,因此可作为辅助诊断 膀胱肿瘤的检测标志物及治疗和预后评估指标。本文将就其在膀胱癌中的研究进展综述如下。     

膀胱移行细胞癌中EphA2的表达和肿瘤MVD计数的关系

目的:探讨膀胱移行细胞癌中EphA2的生物学意义以及EphA2与微血管密度(MVD)的关系。方法:应用免疫组织化学技术检测85例膀胱移行细胞癌及10例正常膀胱粘膜中EphA2的表达,采用CD31染色标记微血管,行肿瘤微血管密度计数。结果:膀胱移行细胞癌和正常膀胱粘膜EphA2表达阳性率分别为89.4%(76/85)、40%(4/10),两组间差异有统计学意义(P<0.01);EphA2表达程度与膀胱癌的病理分级、临床分期和淋巴结转移均有相关性(P<0.05);膀胱移行细胞癌EphA2阴性组与EphA2阳性纽间肿瘤微血管密度(MVD)计数差异有统计学意义(P<0.05),EphA2不同阳性程度组之间MVD计数差异没有统计学意义(P>0.05)。结论:EphA2可作为判定膀胱癌恶性程度的参考指标,与肿瘤微血管生成相关,有望成为膀胱癌治疗的新靶向。     

MTA-1的表达与膀胱移行细胞癌的发生及复发的关系研究

目的:探讨转移相关基因1的表达与膀胱移行细胞癌的发生及复发的关系。方法:收集临床膀胱移行细胞癌患者120例,其中初发病例62例,复发病例58例,采用RT-PCR检测MTA-1 mRNA表达的变化,Western blot检测MTA-1蛋白表达的变化。结果:与对照组比较,初发组病例和复发组病例膀胱癌组织的MTA-1 mRNA和蛋白质的表达水平均明显上调,且复发组上调更为显著。结论:转移相关基因1的表达与膀胱癌的发生呈正相关,且转移相关基因1表达的上调可能导致膀胱移行细胞癌的复发。     

p16、survivin、cyclin D1 在膀胱尿路上皮癌中的表达及意义

目的:探讨抑癌基因p16、细胞周期蛋白cyclin D1和凋亡抑制基因survivin在膀胱移行细胞癌中的表达及意义。方法:膀胱移行细胞癌组67例,10例正常正常膀胱粘膜作为对照,采用免疫组织化学方法检测p16和cyclin D1、survivin蛋白表达,然后分析上述三种蛋白在膀胱癌组织中的表达情况,以及随着不同临床分期和病理分级表达的变化。结果:所有膀胱癌患者平均年龄58.16岁,其中男性患者38例。免疫组织化学分析表明,p16和cyclin D1、survivin蛋白均表达在细胞的细胞核。膀胱癌组织中P16表达明显低于正常对照组,而cyclin D1和survivin表达明显高于正常对照组。随着临床分期的进展,p16表达明显下降,cyclinD1表达明显上升;而随着膀胱癌病理分级升高,p16表达明显下降,survivin表达上升。此外,膀胱癌组织中,p16与cyclin D1p16之间存在着明确的负相关。结论:p16、cyclin D1、survivin在膀胱移行细胞癌的生物学行为中起重要作用,p16,cyclin D1和survivin与膀胱移行细胞癌的恶性进展有关。     

BLCA-4在膀胱癌中作用的研究进展

近年来,膀胱癌的发病率与死亡率呈逐年上升,已成为泌尿系统最常见的肿瘤。随着分子生物技术的不断发展,核基质蛋白（SMVs）、膀胱肿瘤抗原（BTA）、透明质酸和透明质酸酶（HA—Haase）、细胞角蛋O（CK）等诸多膀胱肿瘤标志物被发现。其中,膀胱癌特异性核基质蛋白-4（BLCA-4）是一种可溶性的复合物,在正常膀胱组织中不表达而存在于膀胱癌组织中。检测尿样中BLCA-4水平有望用于膀胱癌的筛查及诊断,具有较高的敏感性和特异性,也可用于普通人群与膀胱癌高危人群（脊髓损伤患者）的筛选与检测;而术后病理组织检测BLCA-4的表达也可为膀胱癌患者的预后预测提供参考。本文对近年来BLCA-4在膀胱癌中的作用进行了综述。     

BLCA-4 在膀胱癌中作用的研究进展

摘要：近年来,膀胱癌的发病率与死亡率呈逐年上升,已成为泌尿系统最常见的肿瘤。随着分子生物技术的不断发展,核基质蛋白 (NMPs)、膀胱肿瘤抗原(BTA)、透明质酸和透明质酸酶(HA-HAase)、细胞角蛋白(CK)等诸多膀胱肿瘤标志物被发现。其中,膀胱癌 特异性核基质蛋白-4(BLCA-4)是一种可溶性的复合物,在正常膀胱组织中不表达而存在于膀胱癌组织中。检测尿样中BLCA-4 水平有望用于膀胱癌的筛查及诊断,具有较高的敏感性和特异性,也可用于普通人群与膀胱癌高危人群(脊髓损伤患者)的筛选与 检测;而术后病理组织检测BLCA-4 的表达也可为膀胱癌患者的预后预测提供参考。本文对近年来BLCA-4 在膀胱癌中的作用进 行了综述。     

STAT3及下游基因Cyclin D1在膀胱癌中的表达及意义

目的 探讨STAT3及下游基因CyclinD1在膀胱癌中的表达及临床意义.为膀胱癌的基因治疗提供理论依据.方法 收集武汉大学人民医院病理科2004-2006年膀胱移行细胞癌存档蜡块50例,其中男性38例,女性12例,平均年龄50.3岁,另取5例癌旁组织做对照.标本均经HE染色,光镜观察诊断,按WHO病理分级标准,G1:30例,G2:15例,G3:5例;运用免疫组织化学染色方法检测STAT3和CyclinD1在以上各组中的表达.利用HPIAS-2000图像分析系统测定STAT3和CyclinD1在以上各组中表达的平均光密度和平均阳性面积率.结果 1.STAT3的表达:STAT3在膀胱移行细胞癌中呈高表达;STAT3在癌旁组织中呈低表达.膀胱移行细胞癌与癌旁组织比较,STAT3的表达差异有显著性(P＜0.05);2.CyclinD1的表达:CyclinD1在膀胱移行细胞癌中呈高表达;CyclinD1在癌旁组织中呈低表达.膀胱移行细胞癌与癌旁组织比较,CyclinD1的表达差异有显著性(P＜0.05).结论 1.STAT3可能参与了膀胱癌细胞的增殖分化、细胞周期等的调节;2.STAT3的活化促进了抗凋亡基因CyclinD1的表达;3.STAT3及其下游基因CyclinD1在膀胱癌的形成中起了一定作用.     

Polι与移行细胞癌发生关系的实验研究

目的:检测DNA聚合酶■(Pol■)在膀胱肿瘤细胞株及移行细胞癌组织中的表达,探讨Pol■在移行细胞癌组织中表达的意义。方法:培养膀胱肿瘤细胞株BIU87细胞、T24细胞株,利用RT-PCR方法检测Pol■在膀胱肿瘤细胞株中的表达;收集人膀胱粘膜正常组织、临床膀胱肿瘤和肾盂癌的移行细胞癌组织标本,利用RT-PCR方法检测组织标本中Pol■的表达。结果:Pol■在膀胱肿瘤细胞株中丰富表达,显著高于膀胱正常粘膜组织(P<0.01);Pol■在膀胱肿瘤及肾盂癌组织的表达显著高于膀胱正常粘膜组织的表达(P<0.01),且与移行细胞癌的分级相关。结论:Pol■在移行细胞癌组织中的高表达可能与膀胱肿瘤的发生、发展相关,为进一步研究Pol■在膀胱肿瘤中表达的意义打下基础。     

一氧化氮合酶（NOS）在膀胱移行细胞癌中的表达及其意义

目的检测膀胱移行细胞癌中一氧化氮合酶（nitric oxide synthase,NOS）的表达,并分析其表达与肿瘤病理特性的关系.方法采用免疫组织化学技术检测35例膀胱移行细胞癌标本、12例癌旁粘膜标本及8例正常膀胱粘膜标本中一氧化氮合酶三种亚型的表达情况.结果 35例肿瘤标本中nNOS、iNOS、eNOS阳性表达率分别为74.3%、85.7%、42.9%,膀胱移行细胞癌中iNOS表达较正常膀胱粘膜增高.但移行细胞癌、癌旁粘膜、正常粘膜三组间nNOS及eNOS表达无差别.nNOS、iNOS、eNOS表达与膀胱移行细胞癌分期分级可能无相关性.结论 iNOS在膀胱移行细胞癌中表达增高,可能参与膀胱移行细胞癌的发生发展.     

CXCR4 和MMP-9 在膀胱移行细胞癌中的表达

目的:探讨CXCR4与MMP-9在膀胱移行细胞癌中表达的相关性及其临床意义.方法:采用免疫组化SP法与半定量RT-PCR检测40例膀胱移行细胞癌组织及10例正常膀胱粘膜组织中CXCR4和MMP-9蛋白及mRNA的表达情况,分析膀胱移行细胞癌组织中CXCR4和MMP-9表达的相关性,分析二者与临床病理特征的关系.结果:膀胱移行细胞癌组织中CXCR4蛋白表达率为77.5％,mRNA相对含量为0,777±0.044;其中浸润深度达肌层者表达率为100％,mRNA相对含量为0.790± 0.049;局限在粘膜下层者表达率为50％,mRNA相对含量为0.660± 0.052;二者之间差异有统计学意义.MMP-9在膀胱移行细胞癌组织中的表达率为80.0％,mRNA相对含量为0.850± 0.079,其中浸润深度达肌层者表达率为95.5％,mRNA相对含量为0.854±0.070,局限在粘膜下层者表达率为61.1％,mRNA相对含量为0.758±0.092,二者之间差异有统计学意义.膀胱移行细胞癌组织中CXCR4及MMP-9蛋白阳性表达呈正相关关系(γ=0.479,P＜0.05).MMP-9与肿瘤组织学分级有关,与患者的性别、年龄无关;而CXCR4的表达与肿瘤组织学分级及患者的性别、年龄均无关.结论:CXCR4和MMP-9表达与膀胱移行细胞癌的发生和浸润密切相关,通过干预CXCR4和MMP-9的活性可能成为治疗膀胱移行细胞癌的新靶点.     

Genetic and epigenetic aspects of bladder cancer

Transitional cell carcinoma of the urinary bladder has a diverse collection of biologic and functional characteristics. This is reflected in differing clinical courses. The diagnosis of bladder cancer is based on the information provided by cystoscopy, the gold standard in combination with urinary cytology findings. Many tumor markers have been evaluated for detecting and monitoring the disease in serum, bladder washes, and urinary specimens. However, none of these biomarkers reported to date has shown sufficient sensitivity and specificity for the detection of the whole spectrum of bladder cancer diseases in routine clinical practice. The limited value of established prognostic markers requires the analysis of new molecular parameters of interest in predicting the prognosis of bladder cancer patients; in particular, the high-risk patient groups at risk of progression and recurrence. Over the past decade, there has been major progress elucidating of the molecular genetic and epigenetic changes leading to the development of transitional cell carcinoma. This review focuses on the recent advances of genetic and epigenetic aspects in bladder cancer, and emphasizes how molecular biology would be likely to affect the future therapies.     

Micropapillary variant of transitional cell carcinoma of the urinary bladder: a report of three cases with cytologic diagnosis in urine specimens

BACKGROUND: Micropapillary transitional cell carcinoma is a recently described, aggressive variant of bladder cancer. Its cytologic features in urine have not been previously characterized. CASES: Three cases illustrate the urinary cytologic features of this high grade urothelial carcinoma and its concurrent biopsy findings. This tumor is similar to low. grade urothelial lesions of the bladder, tends to present as micropapillary clusters in urine and yet has high grade nuclear features within these clusters that help with the differential diagnosis of a flat, high grade urothelial carcinoma. CONCLUSION: The micropapillary type of transitional cell carcinoma is a distinct morphologic entity with an aggressive clinical course. Recognizing its presence in urinary cytology, albeit a rare occurrence, is important in distinguishing this lesion from the more indolent, low grade papillary lesions and high grade urothelial carcinomas, which continuously shed single malignant urothelial cells.     

Cytokeratin expression patterns in normal and malignant urothelium: a review of the biological and diagnostic implications

The cytokeratins are the intermediate filament proteins characteristic of epithelial cells. In human cells, some 20 different cytokeratin isotypes have been identified. Epithelial cells express between two and ten cytokeratin isotypes and the consequent profile which reflects both epithelial type and differentiation status may be useful in tumour diagnosis. The transitional epithelium or urothelium of the urinary tract shows alterations in the expression and configuration of cytokeratin isotypes related to stratification and differentiation. In transitional cell carcinoma, changes in cytokeratin profile may provide information of potential diagnostic and prognostic significance. The intensification of immunolabelling with some CK8 and CK18 antibodies may underly an active role in tumour invasion and foci of CK17-positive cells may represent proliferating populations. Loss of CK13 is a marker of grade and stage and de novo expression of CK14 is indicative of squamous differentiation and an unfavourable prognosis. However, perhaps the most important recent finding is the demonstration that a normal CK20 expression pattern is predictive of tumour non-recurrence and can be used to make an objective differential diagnosis between transitional cell papilloma and carcinoma. This review will consider cytokeratin expression in urothelium and discuss the application of cytokeratin typing to the diagnosis and prognosis of patients with TCC.     

Small cell carcinoma of the bladder. Two cases diagnosed by urinary cytology

BACKGROUND: Primary small cell carcinoma (SCC) of the bladder is a rare but important entity. We report two cases of SCC of the bladder diagnosed by urinary cytology. CASES: A 71-year-old male (case 1) and a 79-year-old female (case 2) presented with asymptomatic gross hematuria. Urinary cytology in case 1 showed the presence of a few undifferentiated malignant small cells and many transitional cell carcinoma (TCC) cells with a bloody and necrotic background. The former cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Pathologic diagnosis after total cystectomy was TCC > SCC > adenocarcinoma, T2M0N0. Urinary cytology of case 2 showed the presence of many undifferentiated malignant small cells and many TCC cells with or without squamous metaplasia. Cytologic features of the former cells were almost the same as those in case 1. Moreover, these cells were neuroendocrine marker positive by immunocytochemistry. Pathologic diagnosis after tumor resection was SCC and TCC > squamous cell carcinoma, T1b. CONCLUSION: The prognosis of primary SCC of the bladder is usually poor. Because our cases were found by urinary cytology at a relatively early stage, both have been well, without any evidence of recurrence, 30 and 25 months after surgery even without adjuvant therapy.     

Metatarsal metastasis from transitional cell cancer of the urinary bladder

Urinary bladder cancers can be grouped into three general categories: superficial, invasive and metastatic. Approximately 90% of malignant tumors of the urinary bladder are of epithelial origin and the majority of them are transitional cell carcinomas (TCC). Metastatic spread of urinary bladder cancers usually includes regional lymph nodes, the lung, the liver and the bones. The presence of metastasis tends to correlate with muscular wall invasion as often demonstrated at the initial diagnosis; consequently clinical bladder cancer represents a late phase of the disease. Although skeletal metastases of bladder cancers are rather common, they have been rarely described to occur in distal bones. For that reason, we report metatarsal metastasis from transitional cell cancer of the urinary bladder in a 59-year-old woman.     

Molecular mechanisms in urinary bladder carcinogenesis

Urinary bladder cancer accounts for approximately 5% of all newly diagnosed malignancies in the developed world. Smoking, occupational exposure and dietary factors constitute the most important exogenous risk factors for bladder carcinogenesis. Yet, individuals with seemingly equal exposure to environmental carcinogens develop bladder cancer in an unpredictable manner. This is probably attributed to the fact that DNA repair capacity varies in human populations, pointing the role of genetic susceptibility in human cancer. Numerous studies demonstrated that certain genetic and epigenetic alterations are fairly constant. Loss of heterozygosity (LOH) at chromosome 9 is an aberration found in urothelial cell carcinoma (UCC) of all stages and grades as well as in dysplastic urothelium, possibly representing an early event in urinary bladder carcinogenesis. On the contrary, gains of 3p can only be found in tumors demonstrating highly malignant behavior. Microsatellite instability (MSI) is another frequent finding in urinary bladder cancer. This has led many investigator groups to employ the analysis for MSI for early diagnosis of UCC with promising results. The silencing of certain genes such as p16(INK4A) and DAPK by aberrant methylation of their promoter region also represents an important mechanism in carcinogenesis. Similarly, alterations in certain tumor suppressor genes and proto-oncogenes result in uncontrolled cell proliferation, reduced apoptosis and have been associated with more aggressive UCC phenotypes. Undoubtedly, the application of these observations in clinical practice will make a breakthrough in the management of bladder cancer.     

Searching urinary tumor markers for bladder cancer using a two-dimensional differential gel electrophoresis (2D-DIGE) approach

Aiming at identifying biomarkers for bladder cancer, the urinary proteome was explored through a two-dimensional gel-based proteomic approach (2D-DIGE) coupled with mass spectrometry and database interrogation. The increased expression of proteins differentially expressed between patients with bladder tumors and controls such as Reg-1 and keratin 10 was confirmed to be associated with bladder cancer progression on bladder cancer cell lines by immunoblotting, and bladder tumors by immunohistochemistry. Moreover, the association of these proteins, especially Reg-1, with tumor staging and clinical outcome was confirmed by immunohistochemistry using an independent series of bladder tumors contained in tissue microarrays (n=292). Furthermore, Reg-1 was quantified using an independent series of urinary specimens (n=80) and provided diagnostic utility to discriminate patients with bladder cancer and controls (area under the curve (AUC=0.88)). Thus, the 2D-DIGE approach has identified Reg-1 as a biomarker for bladder cancer diagnostics, staging, and outcome prognosis.