The Expression Of DEK In Urothelial Caricnom And Clinical Characteristics Of Urothelial Carcinoma In Renal Transplantation Recipients

Part I The expression of DKE in bladder urothelial carcionmaObject i ve:to evaluate the expression of nuclea protein DEK and related proteins of E-cadherin and Ki-67in bladder urothelial caricionma and to provide theoretical evidence for the application of DEK in the evaluation of prognosis of bladder urothelial carcinoma.Methods:Immuhisochemistry technology was used to detect the expression of DEK, E-cadherin and Ki-67in68tissue samples of urothelial bladder,7cases of Inverted urothelial papilloma of the urinary bladder,5cases of atypical hyperplasia and14cases of normal mucosa. Total RNA was extracted with TRIzol reagent, RT-PCR was carried out to indicate the amounts of RNA by use of a gene specific primer. Western blot was used to test the expression of DEK in8cases of urothelial carcinoma. Real-time PCR was used to evaluate the DEK expression in12pairs of urothelial carcinoma specimens.Results:The DEK expression was significantly increased in urothelial carcinoma, as well as inverted urothelial papilloma and atypical heperplasia, but the nomal urothelial cell was negative in14cases. The expression level of DEK inpapillary tumors was higher than in the invasive tumors (P<0.05); the same tendency was observed in two kinds of tumor:in the lower grade urothelial carcinoma the stain signal was more stronger than in higher grade urothelial carcinoma. In tumor cells, the immune activity was observed on nuclear of carcinoma cells, while it became diffused and turned to cytoplasm, even out side of the whole cell in advanced stage or invasive ones. The expression of DEK was not related with patients’age at diagnosis, sex, lymph node involvement. To further confirm the IHC results, the tissue samples were subjected to Real-time PCR and western-blot analysis, the results showed that the DEK expression was higher than the adjacent tumor. Kaplan-Meier analyses revealed that the increased expression of DEK was associated with an decreased disease-free survival in urothelial carcinoma. Survival time of patients with high expression of DEK was significantly shorter that that with lower expression patterns in urothelial carcinoma.Conclusion:There expression patterns of DEK in low grade of urothelial carcinoma was higher than in high grade of bladder urothelial carcinoma, the expression of DKE is correlated with recurrence free survival of urothelial carcinoma patients. The evaluation of DEK expression level was unmeanful to the differated dianosis of inverted papilloma, atypical hyperplasia and urothelial carcinoma. Part Ⅱ Characteristics of upper urinary tract urothelial carcinoma after renal transplantPURPOSE:to establish the incidence of upper urinary tract urothelial carcinoma (UTUC) in a population of renal transplant recipients (RTRs), to describe the clinical presentation, malignancy characteristics, treatment, and outcome of UTUC in this group.PATIENTS AND METHODS:Twenty-four patients (1.01%) of upper urinary tract tumor were identified from2572renal transplant recipients from1998to2011in our institution. The24cases (10men,14women; mean age55.6±9.8(32-70) years, period since transplant2-180months, median54months) included3cases of bladder UTUT,21cases of upper urinary tract tumor (1case of renal cell carcinoma and20cases of upper UTUC). We conducted a retrospective review of the24cases to evaluate the prevalence, treatment, and outcome of upper urinary tract neoplasm in this population.OUTCOMES:Of the24cases3were diagnosed with bladder tumor,1with papillary renal cell carcinoma,5with bilateral renal pelvis and ureter UTUC,15cases with unilateral lesions,8cases with multiple (above2organs) malignancy. Metastasis of multiple lymph nodes occurred in four cases. The follow-up duration was4-94months, median time61months, four died with extensive metastasis, one of them with concomitant renal graft rhabdosarcoma.CONCLUSI ON:upper UTUC was predominant malignancy in our series. The characteristics were involving multiple organs, liable to recurrence, bilateral and with some rare histological type. The role of laxatives in the development of urothelial cancer in RTRs should be emphasized. As a consequence, we suggest that a bilateral nephroureterectomy should be performed prophylactically in patients with proven upper UTUC after renal transplantation.