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目的探讨机体乏氧状态对膀胱癌全膀胱切除术后患者预后的影响。方法 66例膀胱尿路上皮癌行全膀胱切除手术患者,分为机体乏氧状态组(OH组,n=19)和机体常氧状态组(NS组,n=47)。免疫组化检测肿瘤组织缺氧诱导因子1α(HIF-1α)表达和CD105标记的肿瘤微血管密度(MVD)。随访术后生存时间,对比两组患者临床资料,Kaplan-Meier法分析两组生存率,建立Cox模型分析各变量与生存时间的相关性。结果 OH组肿瘤组织HIF-1α表达的阳性率为89.5%(17/19),MVD值为53.1±19.0,中位生存时间为56个月;NS组表达的阳性率为66.0%(31/47),MVD值为40.1±15.2,中位生存时间为82个月;两组临床分期、Hb水平、HIF-1α表达、MVD值间差异有统计学意义(P<0.05)。肿瘤分期高、机体乏氧、HIF-1α高表达和肿瘤高MVD值患者的生存期较短,而高Hb患者的生存期延长(P<0.05或P<0.01)。结论机体乏氧状态下的膀胱癌组织HIF-1α表达上升,肿瘤微血管密度增加,不利于患者预后。
Objective To investigate the effect of hypoxia on the prognosis of patients with bladder cancer after total cystectomy. Methods 66 patients with bladder urothelial carcinoma undergoing total cystectomy were divided into three groups: the hypoxic group (OH group, n = 19) and the normoxic group (NS group, n = 47). Immunohistochemistry was used to detect the expression of hypoxia inducible factor 1α (HIF-1α) and CD105-labeled tumor microvessel density (MVD). Survival time was followed up. The clinical data of two groups were compared. Kaplan-Meier method was used to analyze the survival rate of two groups. Cox model was established to analyze the relationship between variables and survival time. Results The positive rate of HIF-1α expression in OH group was 89.5% (17/19), the MVD was 53.1 ± 19.0 and the median survival time was 56 months. The positive expression rate of NS in NS group was 66.0% (31/47) ), The MVD was 40.1 ± 15.2 and the median survival time was 82 months. There was significant difference between the two groups in clinical stage, Hb level, HIF-1α expression and MVD (P <0.05). Patients with high tumor staging, hypoxemia, high HIF-1α expression and high tumor MVD had shorter survival, whereas those with high Hb prolonged survival (P <0.05 or P <0.01). Conclusions The expression of HIF-1α in bladder cancer tissue under hypoxia condition increases and the microvessel density of tumor increases, which is unfavorable to the prognosis of patients.