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目的：观察ｒａｓ癌基因产物ｐ２１－ｒａｓ蛋白及癌胚抗原ＣＥＡ在膀胱移行细胞癌（ＴＣＣ）中的表达及与病理分级间的关系、并探讨其在预后判断中的意义。方法：采用免疫组织化学ＡＢＣ法对存档的膀胱ＴＣＣ５４例石蜡标本中ｐ２１－ｒａｓ及ＣＥＡ的表达进行检测，同时取膀胱癌旁不典型增生（Ⅰ－Ⅱ级）１２例及切除标本残端正常的膀胱粘膜标本１４例作对照。所得结果皆经秩和检验及秩和相关分析。结果：ｐ２１－ｒａｓ在膀胱ＴＣＣ各级中表达阳性率分别为Ⅰ级８５．７％，Ⅱ级７６．９％，Ⅲ级４２．８％；而ＣＥＡ在膀胱ＴＣＣ各级中表达阳性率分别为Ⅰ级２１．４％，Ⅱ级３８．５％，Ⅲ级８５．７％。ｐ２１－ｒａｓ与膀胱ＴＣＣ预后间关系非常显著（Ｐ＜０．０１），而ＣＥＡ与膀胱ＴＣＣ预后间关系显著（Ｐ＜０．０５）。结论：ｐ２１－ｒａｓ阳性率随膀胱ＴＣＣ的病理分级增高而降低，而ＣＥＡ阳性率随膀胱ＴＣＣ的病理分级增高而增加，ｐ２１－ｒａｓ阳性率与预后呈正相关，ＣＥＡ阳性率与预后呈负相关。结合上述两种参数对膀胱ＴＣＣ预后进行判断，其准确性要高于单凭ｐ２１－ｒａｓ或ＣＥＡ表达情况进行分析。
OBJECTIVE: To observe the expression of p21-ras protein and carcinoembryonic antigen CEA in bladder transitional cell carcinoma (TCC) and its relationship with pathological grade, and to explore its significance in the prognosis. Methods: Immunohistochemical ABC method was used to detect the expression of p21-ras and CEA in the paraffin-embedded specimens of paraffin-embedded TCC of 54 cases. At the same time, 12 cases with atypical hyperplasia of bladder cancer (Ⅰ-Ⅱ grade) and normal stump 14 cases of bladder mucosa as a control. The results obtained by rank sum test and rank correlation analysis. Results: The positive rates of p21-ras expression in bladder TCC were 85.7% in grade Ⅰ, 76.9% in grade Ⅱ and 42.8% in grade Ⅲ, respectively. The positive rates of CEA in bladder TCC were Grade I 21.4%, Grade II 38.5%, Grade III 85.7%. There was a significant correlation between p21-ras and bladder TCC prognosis (P <0.01), while there was a significant correlation between CEA and bladder TCC prognosis (P <0.05). Conclusion: The positive rate of p21-ras decreases with the increase of pathological grade of bladder TCC. The positive rate of CEA increases with the increase of pathological grade of bladder TCC. The positive rate of p21-ras is positively correlated with prognosis. The positive rate of CEA is negatively correlated with prognosis. Combined with the above two parameters to judge the prognosis of bladder TCC, its accuracy is higher than that of p21-ras alone or CEA expression analysis.