ALDH1Expression As Tumor Stem Cells Marker And Its Relationship To Clinicopathologic Parameters And Prognosis In Invasive Bladder Cancer

Objective: The purpose of our experiments is to investigate the effect ofaldehyde dehydrogenase1(ALDH1) as tumor stem cells marker on thebiological behavior of invasive bladder cancer.Methods:109cases of primary invasive carcinomas specimens and26cases of37cases pelvic lymph node dissection were assembled as experimentalgroup while20cases of normal bladder tissue surrounding cancer werecollected as control group.Analysis: The expression of ALDH1protein weredetected by immunohistochemistry in experimental group and control group.Results:1. The expression of ALDH1in invasive bladder cancer andadjacent normal bladder tissue by immunohistochemistry.In109cases of invasive bladder cancer, the rate of ALDH1positiveexpression was33.94%（37/109）. In20cases of adjacent normal bladder tissue,the rate of ALDH1positive expression was5.00%（1/20）.The expression wassignificantly different between the two groups (P <0.01).2. The expression of ALDH1in local lymph nodes of invasive bladdercancer by immunohistochemistry.There were37cases of local lymph nodes of invasive bladder cancer.In6metastatic lymph nodes, the rate of ALDH1positive expression was50.00%（3/6）. No expression in20cases of normal local lymph nodes. The expressionwas significantly different between the two groups (P <0.01).3. The relationship between ALDH1expression and the clinicopathologicfeatures of bladder cancer. The positive rate of ALDH1expression in low-grade group andhigh-grade group bladder cancer was13.04%(3/23) and39.53%(34/86)respectively, and the difference was statistically significant(P<0.05). Thepositive rate of ALDH1expression in non-muscle invasive group and muscleinvasive group bladder cancer was19.05%(8/42) and43.28%(29/67)respectively. The difference was statistically significant(P<0.05). There were6cases of lymphatic metastasis in37cases of pelvic removal of regional lymphnodes. The positive rate of ALDH1expression in bladder cancer of lymphaticmetastasis group and without lymphatic metastasis group was50.00%(3/6) and12.90%(4/31) respectively. The difference was statistically significant(P<0.05).Statistics show that ALDH1expression in bladder cancer is not correlated withpatients gender and age and tumor size and tumor maiden or recurrence.4. Survival data analysis.The patients of retaining the bladder were performed drug perfusionchemotherapy after surgery, and patients of lymphatic metastasis or positivebladder cut edge or neural and vascular cancer invasion were performedadjuvant systemic chemotherapy. In bladder cancer postoperative patientsfollowed up for4-65months, the cumulative overall survival rate ofALDH1-positive group and ALDH1-negative group are64.86%(24/37) and84.72%(61/72) respectively. Kaplan-Meier analysis and the log-rank testshowed that the cumulative overall survival rate was statistically differentbetween the ALDH1-positive group and the ALDH1-negative group(P<0.05).The cumulative disease-free survival rate of ALDH1-positive group andALDH1-negative group are51.40%(19/37) and75.00%(54/72)respectively．The difference was statistically significant(P<0.05).Conclusion:1. The positive rate of ALDH1expression in invasivebladder is higher than it in the adjacent normal bladder tissue, suggesting thatthe high expression of ALDH1may be correlated with the occurrence of bladder cancer. It may be important for the early diagnosis of bladder cancer.2. ALDH1in the high stage and high grade bladder cancer was highlyexpressed, while the expression of ALDH1in metastatic lymph nodes is higherthan it in the normal local lymph nodes. It may be used as an index of grade,stage of bladder cancer. The expression of ALDH1in lymphatic metastasisgroup is higher than it in the and without lymphatic metastasis group,suggesting that ALDH1is correlated with lymphatic metastasis.ALDH1expression in bladder cancer is not correlated with gender, age and tumor sizeand tumor maiden or recurrence.3. In bladder cancer postoperative patients followed up for6-42months,the cumulative overall survival rate of ALDH1-positive group is higher thanthat of ALDH1-negative group and the cumulative disease-free survival rate ofALDH1-positive group is higher than that of ALDH1-negative group.ALDH1may be one of the useful indexes of bladder cancer prognosis.