【作者】 曹琦；

【导师】 于德新；

【作者基本信息】 安徽医科大学 ， 外科学， 2013， 硕士

【摘要】 目的：研究膀胱尿路上皮癌发生淋巴结微转移(LNM)的概率和影响因素，并分析LNM与5年生存率的关系。方法：纳入PT1-4N0M0膀胱尿路上皮癌患者128例，均行根治性全膀胱切除术，术后随访7～112个月。应用免疫组化SP法观察尿溶蛋白Ⅱ(UPⅡ)和细胞角蛋白20（CK20）在手术清扫淋巴结中的表达情况，分析相关临床和病理因素与UPⅡ、CK20表达的关系，并对发生LNM（UPⅡ和CK20表达阳性）患者与未发生LNM患者5年生存率的差异进行统计分析。结果：128例患者中，39例（30.47%）患者的淋巴结中找到阳性表达的肿瘤细胞，证实发生LNM。25例患者经UPⅡ抗体检测出现LNM，发生率为19.53%(25/128)，CK20抗体检测24例患者出现LNM,发生率为18.75%(24/128)，两者联合检测可提高LNM检出率（P<0.05)。LNM与肿瘤的病理分期、分级相关（P<0.05)，但与患者的年龄、性别及肿瘤大小、数目无关。出现LNM的患者与未出现LNM患者的术后5年生存率分别为41.03%、68.54%，差异有统计学意义(P<0.01)。结论：使用UPⅡ和CK20联合免疫组化检测膀胱癌淋巴结可提高LNM的检出率。高分期与和高分级的膀胱癌容易发生LNM。发生LNM的患者，预后相对较差。更多还原

【Abstract】 Objective: To evaluate the probability and impact factors of lymph nodemicrometastasis(LNM) in patients with bladder urothelial cancer(PT1-4N0M0),andinvestigate the relationship between LNM and5-year survival rate.Methods：128bladder cancer patients followed up for7to112months after radicalcystectomy were enrolled. The expression of Uroplakin Ⅱ (UP Ⅱ) andCytokeratin20(CK20)were examined in lymph nodes by SP immunohistochemistry aftersurgical lymphadenectomy. The relationship between clinical parameters, pathologicparameters and UPⅡ, CK20expression was analyzed.The difference of5-year survivalrates between patients with and without LNM was statistically analyzed.Results：39cases found positively stained lymph nodes which suggested LNM.Immunohistochemical analysis of25cases was positive for UPⅡ,and immunohistochemicalanalysis of24cases was positive for CK20. Combined method with UPⅡ and CK20couldenhance the detection rate of LNM. LNM of bladder cancer was statistically associated withpathological stage and grade(P<0.05) rather than patients,age, gender and tumor size,number. The5-year survival rates in patients with and without LNM were41.03%and68.54%, the difference was statistically significant(P<0.01).Conclusion：Immunohistochemical method combined with UPⅡ and CK20can enhancethe detection rate of LNM for bladder cancer. Patients with high tumor stage(T3-4) or grade(G3)are easily to emerge LNM. The patients with LNM always have a poor prognosis.更多还原