The Value Of Immunohistochemical Indicators In Staging And Grading Of Non Muscle Invasive Bladder Cancer

To evaluatethe staging and grading of Ki-67,TP53,Cyclin D1,HER-2 in non-muscle invasive bladder cancer(NMIBC).Methods: Retrospective analysis was performed on the Ta,T1 NMIBC of clinicopathologic characteristics of 184 patients who underwent transurethral resection of the bladder(TURBT)at the Tianjin Medical University Cancer Institute and Hospital from January 2015 to December 2016.The expression of Ki-67,TP53,Cyclin D1 and HER-2 was evaluated using immunohistochemical assay.Then,the association between immunohistochemical indicators expression and staging and grading of non muscle invasive bladder cancer were assessed by univariate analyses.The independent factors of staging and grading in NMIBC were assessed by multivariate logistic analysis,and calculate and compare their sensitivity and specificityResults: 1.We retrospectively collected the clinicopathologic data of patients with TURBT at Tianjin Medical University Cancer Institute and Hospital and all patients pathologically diagnosed with Ta and T1 NMIBC.The patients between the ages of 26 to 90 who participated in this study,the median patient age was 58 years.The tumor size was less than 3 cm in 142 cases(77.2%),the tumor size was greater than 3 cm in 42 cases(22.8%),the tumor in a single case in 113 cases(61.4%),and the tumor in multiple cases in 71 cases(38.6%);The primary tumor is 149 cases(81.0%),35 cases(19.0%)had recurrenced.Postoperative pathological examinaton of G1 and G2 grades were 102 cases(55.4%),G3 grade was 82 cases(44.6%),Ta stage was 125 cases(67.9%),T1 stage 59 was cases(32.1%).2.The expression of each index was detected by immunohistochemical technique: The best cut-off points of Ki-67,TP53,Cyclin D1,and HER-2 were determined by ROC curves,which were 25%,75%,45%,and 70%,respectively.The high expression of Ki-67 was present in 41.8%(77/184),the high expression of TP53 was present in 27.7%(51/184),the high expression of Cyclin D1 was present 84.2%(155/184),and high expression of HER-2 was 22.8%(42/184).3.The clinicopathologic feature and immunohistochemistry indictors was associated with NMIBC stage and grade:Single factor analysis showed that the tumor diameter was positively correlated with NMIBC stage and grade(P<0.05),T1 stage and High expression of Ki-67 and HER-2 in G3 grade tissues was positively correlated with stage and grade(P<0.05).Ta stage of NMIBC and high expression of Cyclin D1 in pathological G1 and G2 tissues were negative correlation between stage and grade(P<0.05).A multivariate analysis was performed using meaningful indicators showed by univariate analysis in a Logistic regression model.The results showed that Ki-67 was high expression and Cyclin D1 was low expression as an independent predictor of T1 stage of NMIBC(P<0.01).The high expression of Ki67,the high expression of HER-2 and low expression of Cyclin D1 was independent predictor of G3 grade in NMIBC(P<0.01).4.The sensitivity and specificity of each index were detected by immunohistochemial technique: The sensitivity and specificity of immunohistochemistry indictor of Ki-67 which was predicted NMIBC stage and grade were higher than indictors of Cyclin D1 and HER-2.Conclusion: The immunohistochemistry indictors of Ki-67 expression level was positively correlated with stage and grade in NMIBC.It was an independent predicted factors of stage and grade in NMIBC.Because of its high sensitivity,specificity and easy option for application,which was aiso used for patients with sometimes differential diagnosis difficulty of staging and grading in NMIBC.The result showed that it more suitable for clinical applications.