Division of Urology, Kobe University, Graduate School of Medicine, Kobe, Japan.
Urology. 2011 Dec;78(6):1443.e7-12. doi: 10.1016/j.urology.2011.07.1388. Epub 2011 Sep 15.
To investigate the impact of the expression profile of E-cadherin and N-cadherin in urothelial carcinoma of the upper urinary tract (UC-UUT) on the probability of intra- and extravesical disease recurrence in patients undergoing nephroureterectomy.
This study included 59 consecutive patients diagnosed as having clinically localized UC-UUT who underwent nephroureterectomy. Expression levels of E-cadherin and N-cadherin in resected specimens from these patients were measured by immunohistochemical staining.
In this series, intra- and extravesical recurrence occurred in 20 (33.9%) and 19 (32.2%) patients, respectively. Both intra- and extravesical recurrence-free survivals significantly favored patients with positive E-cadherin or negative N-cadherin expression compared with those of patients with reduced E-cadherin or positive N-cadherin expression, respectively. Univariate analysis identified pathologic T stage, multifocality, and N-cadherin expression as significant predictors of intravesical recurrence, of which multifocality and N-cadherin expression were independently related to intravesical recurrence-free survival on multivariate analysis. Furthermore, pathologic T stage, grade, lymph node metastasis, E-cadherin expression, and N-cadherin expression were significantly associated with extravesical recurrence-free survival on univariate analysis. Of these significant factors, pathologic T stage, grade, lymph node metastasis, and N-cadherin expression were shown to be independent predictors of extravesical recurrence on multivariate analysis.
These findings suggest that expression profiles of E-cadherin and N-cadherin, particularly the gain of N-cadherin rather than loss of E-cadherin expression, in UC-UUT appeared to be significantly associated with disease recurrence after nephroureterectomy.
探讨上尿路尿路上皮癌（UC-UUT）中 E-钙黏蛋白和 N-钙黏蛋白表达谱对上尿路尿路上皮癌患者行肾输尿管切除术（Nephroureterectomy）后发生膀胱内外疾病复发的概率的影响。
本研究纳入了 59 例经临床诊断为局限性 UC-UUT 并接受肾输尿管切除术的连续患者。通过免疫组织化学染色法测量了这些患者切除标本中 E-钙黏蛋白和 N-钙黏蛋白的表达水平。
在本系列中，20 例（33.9%）和 19 例（32.2%）患者分别发生了膀胱内和膀胱外复发。与 E-钙黏蛋白表达降低或 N-钙黏蛋白表达阳性的患者相比，E-钙黏蛋白阳性或 N-钙黏蛋白阴性表达的患者的膀胱内外无复发生存均显著较好。单因素分析确定病理 T 分期、多灶性和 N-钙黏蛋白表达是膀胱内复发的显著预测因素，其中多灶性和 N-钙黏蛋白表达在多因素分析中与膀胱内无复发生存独立相关。此外，病理 T 分期、分级、淋巴结转移、E-钙黏蛋白表达和 N-钙黏蛋白表达在上尿路尿路上皮癌无复发生存的单因素分析中均显著相关。在这些显著因素中，病理 T 分期、分级、淋巴结转移和 N-钙黏蛋白表达在多因素分析中被证明是膀胱外复发的独立预测因素。
这些发现表明，UC-UUT 中 E-钙黏蛋白和 N-钙黏蛋白的表达谱，特别是 N-钙黏蛋白的获得而不是 E-钙黏蛋白的丢失，在上尿路尿路上皮癌患者行肾输尿管切除术后与疾病复发显著相关。
