Expression of CHI3L1 and SOX7 in bladder cancer and their relationship with recurrence after transurethral resection of bladder tumor
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摘要: 目的 探究膀胱癌组织壳多糖酶3样蛋白1(chitosanase 3-like protein 1，CHI3L1)、Y性别决定基因7(sex determining region Y-box，SOX7)表达及与经尿道膀胱肿瘤电切术(transurethral resection of bladder tumors，TURBT)术后复发的关系。方法 收集2019年8月—2021年8月保定市第二医院收治的146例行TURBT的膀胱癌患者作为观察对象，取患者癌组织和癌旁组织，采用免疫组织化学法测定膀胱癌组织和癌旁组织CHI3L1、SOX7蛋白表达，对患者进行2年随访，根据术后复发情况，分为复发组32例和未复发组114例，采用logistic回归分析膀胱癌患者TURBT术后复发的影响因素，四格表分析膀胱癌组织CHI3L1、SOX7蛋白表达对TURBT术后复发的预测价值。结果 膀胱癌组织CHI3L1阳性表达率(65.75%)显著高于癌旁组织(34.93%)，SOX7阳性表达率(41.10%)显著低于癌旁组织(73.29%)(P<0.05)。肿瘤数目多发、T1期的膀胱癌组织CHI3L1阳性表达和SOX7阴性表达的患者比例显著高于肿瘤数目单发、Ta期的患者比例(P<0.05)。CHI3L1是膀胱癌患者TURBT术后复发的独立危险因素，SOX7是复发的保护因素(P<0.05)。CHI3L1、SOX7联合预测术后复发的特异度、准确度高于各自单独预测，误诊率低于各自单独预测(P<0.05)。结论 在膀胱癌组织中CHI3L1表达水平较高，SOX7表达水平较低，二者与患者临床病理特征以及TURBT术后复发有关，可能作为膀胱癌患者行TURBT术后预后评估的标志物。
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关键词:
- 膀胱癌 /
- 壳多糖酶3样蛋白1 /
- Y性别决定基因7 /
- 经尿道膀胱肿瘤电切术 /
- 复发
Abstract: Objective To investigate the expression of chitosanase 3-like protein 1(CHI3L1) and sex determining region Y-box 7(SOX7) in bladder cancer tissue and their relationship with the recurrence after transurethral resection of bladder tumor(TURBT).Methods A total of 146 cases of bladder cancer treated by TURBT in Baoding Second Hospital from August 2019 to August 2021 were collected as observation objects, then immunohistochemical method was applied to detect the expression of CHI3L1 and SOX7 proteins in bladder cancer tissues and adjacent tissues. Patients were followed up for 2 years and grouped into a recurrence group of 32 cases and a non-recurrence group of 114 cases based on postoperative recurrence. Logistic regression was applied to analyze the factors influencing the recurrence of bladder cancer after TURBT, and the predictive value of CHI3L1 and SOX7 protein expression in bladder cancer tissues for recurrence after TURBT was analyzed by four-fold table.Results The positive expression rate of CHI3L1 in bladder cancer tissues (65.75%) was obviously higher than that in adjacent tissues (34.93%), while the positive expression rate of SOX7 (41.10%) was obviously lower than that in adjacent tissues (73.29%) (P<0.05). The proportions of positive expression of CHI3L1 and negative expression of SOX7 in patients with multiple tumors, and T1 tumor stage were obviously higher than those in patients with single tumor and Ta tumor stage (P<0.05). CHI3L1 was an independent risk factor in recurrence of bladder cancer after TURBT, while SOX7 was a protective factor in recurrence (P<0.05). The specificity and accuracy of CHI3L1 and SOX7 combined to predict postoperative recurrence were higher than those of each individual prediction, and the misdiagnosis rate was lower than that of each individual prediction(P<0.05).Conclusion CHI3L1 is highly expressed, while SOX7 is lowly expressed in bladder cancer tissues. Both are related to the clinicopathological characteristics of patients and the recurrence after TURBT, so they may be used as markers for the prognosis evaluation of bladder cancer after TURBT. -
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表 1 膀胱癌组织与癌旁组织CHI3L1、SOX7表达水平比较
例(%) 组别 例数 CHI3L1阳性表达 SOX7阳性表达 癌旁组织 146 51(34.93) 107(73.29) 膀胱癌组织 146 96(65.75) 60(41.10) χ2 27.741 30.900 P值 <0.001 <0.001 
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表 2 膀胱癌组织CHI3L1、SOX7表达水平与临床病理特征关系
例(%) 临床病理特征 例数 CHI3L1阳性(96例) CHI3L1阴性(50例) χ2 P值 SOX7阳性(60例) SOX7阴性(86例) χ2 P值 年龄/岁 3.014 0.093 1.609 0.205 <60 76 45(46.88) 31(62.00) 35(58.33) 41(47.67) ≥60 70 51(53.12) 19(38.00) 25(41.67) 45(52.33) 性别 2.601 0.107 0.945 0.331 男 80 48(50.00) 32(64.00) 30(50.00) 50(58.14) 女 66 48(50.00) 18(36.00) 30(50.00) 36(41.86) 吸烟 1.143 0.285 0.025 0.875 有 67 41(42.71) 26(52.00) 28(46.67) 39(45.35) 无 79 55(57.29) 24(48.00) 32(53.33) 47(54.65) 饮酒 1.596 0.168 0.837 0.360 有 82 50(52.08) 32(64.00) 31(51.67) 51(59.30) 无 64 46(47.92) 18(36.00) 29(48.33) 35(40.70) 危险度 3.440 0.064 3.037 0.081 低、中危 75 44(45.83) 31(62.00) 36(60.00) 39(45.35) 高危 71 52(54.17) 19(38.00) 24(40.00) 47(54.65) 肌瘤直径/cm 2.059 0.151 1.253 0.263 <3 82 58(60.42) 24(48.00) 37(61.67) 45(52.33) ≥3 64 38(39.58) 26(52.00) 23(38.33) 41(47.67) 肿瘤数目 10.560 0.001 21.539 <0.001 单发 81 44(45.83) 37(74.00) 47(78.33) 34(39.53) 多发 65 52(54.17) 13(26.00) 13(21.67) 52(60.47) T分期 7.733 0.005 6.351 0.012 Ta 79 44(45.83) 35(70.00) 43(71.67) 36(41.86) T1 67 52(54.17) 15(30.00) 17(28.33) 50(58.14)
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表 3 影响膀胱癌TURBT术后复发的单因素分析
例(%) 因素 例数 复发组(32例) 未复发组(114例) χ2 P值 年龄/岁 0.289 0.591 <60 76 18(56.25) 58(50.88) ≥60 70 14(43.75) 56(49.12) 性别 0.046 0.830 男 80 17(53.12) 63(55.26) 女 66 15(46.88) 51(44.73) 吸烟 0.016 0.899 有 67 15(46.88) 52(45.61) 无 79 17(53.12) 62(54.39) 饮酒 <0.001 0.991 有 82 18(56.25) 64(56.14) 无 64 14(43.75) 50(43.86) 危险度 3.156 0.076 低、中危 75 12(37.50) 63(55.26) 高危 71 20(62.50) 51(44.74) 肌瘤直径/cm 1.436 0.231 <3 82 15(46.88) 67(58.77) ≥3 64 17(53.12) 47(41.23) 肿瘤数目 7.390 0.007 单发 81 11(34.38) 70(61.40) 多发 65 21(65.63) 44(38.60) T分期 11.144 0.001 Ta 79 9(28.12) 70(61.40) T1 67 23(71.88) 44(38.60) CHI3L1 8.607 0.003 阳性 96 28(87.50) 68(59.65) 阴性 50 4(12.50) 46(40.35) SOX7 18.755 <0.001 阳性 60 2(6.25) 58(50.88) 阴性 86 30(93.75) 56(49.12)
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表 4 影响膀胱癌患者TURBT术后复发的多因素logistic回归分析
因素 B SE Waldχ2 OR 95%CI P值 肿瘤数目 0.527 0.285 3.420 1.694 0.969~2.961 0.064 T分期 0.561 0.491 1.307 1.753 0.700~4.589 0.253 CHI3L1 0.970 0.364 7.102 2.638 1.293~5.384 0.008 SOX7 -0.203 0.092 4.885 0.816 0.681~0.977 0.027
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表 5 膀胱癌组织CHI3L1、SOX7单独及联合预测TURBT术后复发的四格表
例 分组 CHI3L1 SOX7 联合 合计 复发 未复发 复发 未复发 复发 未复发 复发 28 4 30 2 27 5 32 未复发 68 46 56 58 36 78 114 合计 96 50 86 60 63 83 146
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表 6 膀胱癌组织CHI3L1、SOX7单独及联合对TURBT术后复发的预测效能比较
% 预测方法 灵敏度 特异度 准确度 误诊率 CHI3L1 87.50(28/32) 40.35(46/114)1) 50.68(74/146)1) 59.65(68/114)1) SOX7 93.75(30/32) 50.88(58/114)1) 60.27(88/146)1) 49.12(56/114)1) 联合 84.38(27/32) 68.42(78/114) 71.92(105/146) 31.58(36/114) 与联合比较，1)P<0.05。
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