膀胱肿瘤的无创诊断

膀胱肿瘤的早期、无创诊断技术是近年研究的热门课题,对于指导临床治疗和预后均有重要意义。现综述膀胱肿瘤的无创诊断方法及近年来的研究进展,并与传统的尿脱落细胞学检查等现有的膀胱肿瘤无创诊断方法进行比较。     

膀胱肿瘤的无创诊断

膀胱肿瘤的早期、无创诊断技术是近年研究的热门课题,对于指导临床治疗和预后均有重要意义。现综述膀胱肿瘤的无创诊断方法及近年来的研究进展,并与传统的尿脱落细胞学检查等现有的膀胱肿瘤无创诊断方法进行比较。     

膀胱混合癌的诊断和治疗

 目的　提高膀胱混合癌的诊治水平。方法　回顾分析 1 990年 1月至 2 0 0 0年 6月收治的 1 2例病人 ,结合文献就其临床表现、诊断和治疗以及预后情况进行讨论。结果　 1 2例膀胱混合癌占同期 5 49例膀胱肿瘤的 2 .1 9% ,其中鳞、腺混合癌 3例 ,移行、鳞状、腺细胞混合癌 1例 ,移行、鳞状细胞混合癌 6例 ,移行、腺细胞癌混合癌 2例。行膀胱部分切除术 9例 ,全膀胱切除 2例 ,根治性全膀胱切除 1例。术后 1 2例患者均接受定期随访 ,生存期 7个月～ 4.2年。结论　膀胱混合癌的恶性程度高 ,预后极差 ,手术切除仍是主要的治疗方法 ,早期诊断是提高生存率的关键     

Evaluation of two new urinary tumor markers: bladder tumor fibronectin and cytokeratin 18 for the diagnosis of bladder cancer.

Our objectives were to evaluate the diagnostic value of two new urinary tumor markers, cytokeratin 18 (CK18) and bladder tumor fibronectin (BTF), for the detection and monitoring of bladder cancer. The study comprised 931 urine samples belonging to 402 subjects: 112 individuals under suspicion for a primary bladder tumor (group 1); 104 bladder cancer patients under scheduled follow-up (group 2); 109 bladder cancer patients receiving intravesical instillations (group 3); 45 patients with other urological diseases (group 4); and 32 healthy subjects (group 5). Voided urine samples were collected before cystoscopies, between them and before intravesical instillations. CK18 and BTF tests were measured by chemiluminescent immunoassays. Optimal receiver operating characteristic cutoffs of 7.4 microg/L for CK18 and 52.8 microg/liter for BTF rendered overall sensitivities of 66.2% for CK18 and 80.0% for BTF at specificities of 88.4 and 74.7%, respectively. Urinary cytology provided a sensitivity of 29.2% at a specificity of 99.1%. Sensitivities were 80.8, 74.2, and 82.3% for BTF and 71.1, 77.4, and 64.7% for CK18 for groups 1 to 3, respectively. False positive rates were higher for BTF in all groups of patients. Elevated urinary tumor markers during the monitoring of patients with bladder cancer could detect recurrence sooner than scheduled cystoscopies. Persistence of negative markers was greatly indicative of free of disease status in follow-up. CK18 and BTF in urine may eventually prove to be of benefit for specific patients with bladder carcinoma given its higher sensitivity compared with cytology. In selected patients, namely those with persistent negative urinary CK18 and BTF, the number of cystoscopies could be reduced.     

尿膀胱肿瘤抗原在膀胱癌诊断中的临床价值及相关性分析

目的分析尿膀胱肿瘤抗原(BTA)在膀胱癌筛查中的临床应用价值及影响因素。方法回顾性分析76例膀胱癌和42例泌尿系统良性疾病患者的临床资料,采用酶联免疫吸附测定(ELISA)检测尿液BTA浓度和尿脱落细胞阳性表达情况。采用受试者工作特征曲线(ROC)确定截断点、灵敏度、特异度和曲线下面积(AUC),采用秩和检验比较BTA和尿脱落细胞学检查的AUC差异;相关性分析采用Spearman相关分析。结果 BTA检测的最佳截断点为91.74 ng/ml,且AUC明显大于尿脱落细胞学检查(P﹤0.01)。膀胱癌患者尿液中BTA含量明显高于良性疾病组患者(P﹤0.01)。BTA检测的灵敏度为89.47%(68/76),明显高于尿脱落细胞学检查的38.16%(P﹤0.01)。BTA阳性检测结果与血尿浓度、TNM分期、WHO病理组织学分级呈正相关(P﹤0.05),尿脱落细胞学检查结果仅与膀胱癌患者TNM分期呈正相关(P﹤0.05)。结论尿BTA检查灵敏度和特异度较高,可用于膀胱癌早期无创性筛查。     

Ethylchlorformate polymerized tumor protein immunotherapy of the murine bladder tumor

Using murine transplantable transitional cell carcinoma (MBT2), the effect of ethylchlorformate (ECF) polymerized tumor protein was compared with that of bacillus Calmette-Guerin (BCG). Seventy-five C3H/He mice were challenged with an intradermal inoculation of 5 X 10(5) viable MBT2 tumor cells and divided into five groups. Each group was intradermally administered with 0.01 mg of ECF (low ECF), 0.25 mg of ECF (high ECF), 0.1 mg of ECF and 10(6) CFU BCG (ECF/BCG), 10(6) CFU of BCG alone or normal saline (control) weekly for 10 weeks. The mean survival rate for the treatment groups was 64 to 73 days and significantly longer than that for the control group (P less than 0.001, Savage). The incidence of biologically active tumor progression was significantly less for the treatment groups (low ECF, 53%; high ECF, 33%; ECF/BCG, 7%; BCG, 27%) compared with the control group (87%; P less than 0.5, chi-square. The mean rate of tumor growth was significantly lower for all treatment groups than for the control group (P less than 0.001, ANOVA and SNK), and the ECF/BCG group had the lowest growth rate despite a higher incidence of local granulomatous reaction. In this study, immunotherapy significantly prolonged the survival rate, decreased the incidence of biologically active tumor progression, and slowed the rate of tumor growth. The combination of ECF polymerized tumor protein and BCG had the greatest effect, suggesting that the effect of the vaccine was increased with BCG.     

ALA fluorescent diagnosis of bladder cancer

Application of 5-aminolauvulin acid (ALA) fluorescence allows to detect not only exophytic tumors of the bladder but also flat, small tumors-satellites and preneoplastic changes of the bladder. 175 biopsies were performed in 53 patients with suspected superficial tumor of the bladder. 3 hours before surgery all the patients were intravesically instilled 50 ml 3% ALA solution. Cystoscopy employed white and blue light. Visual registration of exophytic masses and red fluorescence of the suspected sites was registered and consequently compared to the histological findings. 96 of 100 sites with malignancy/dysplasia showed red fluorescence. In 13% patients cancer and mucosal dysplasia were detected only under the blue light and were missed by standard cystoscopy. Residual red fluorescence of the resection margins was observed in 41% patients after TUR. Sensitivity of ALA-fluorescent detection reached 96%, specificity 52%. ALA-induced fluorescent diagnosis is more effective than standard cystoscopy. It is most effective in diagnosis of dysplasias, carcinoma in situ, flat, small, multiple superficial tumors of the bladder during primary TUR.     

Invadopodia formation by bladder tumor cells

A major cause of death in patients with bladder tumors is recurrence with metastasis. Bladder tumor metastasis is largely dependent upon the invasive capacity of tumor cells. Tumor cell invasion is mainly mediated by actin-rich protrusive membrane structures called invadopodia. The formation of invadopodia was observed in various types of invasive tumors such as breast cancer and melanomas. However, invadopodia formation so far has not been described in bladder tumor cells. We here report that human bladder tumor cells form functionally active invadopodia. By using a confocal laser scanning microscope, we demonstrated that invasive bladder tumor cell lines, YTS-1 and T24, with high Matrigel degradation activity form invadopodia but that noninvasive bladder tumor cell lines, RT4 and KK-47, form no detectable invadopodia. Invadopodia formed by YTS-1 cells had the ability to secrete matrix metalloproteases and degrade extracellular matrix to invade surrounding areas. Moreover, we observed that primary tumor cells obtained from patients with invasive bladder tumors also form invadopodia, validating the results from bladder tumor cell lines. Our results provide evidence that invasive human bladder tumor cells form invadopodia for tumor invasion.     

Adjuvant chemotherapy after cystectomy of bladder tumor

Adjuvant chemotherapy mainly consisting of cisplatin, adriamycin and mitomycin C was administered to 17 patients after cystectomy for bladder tumor (chemotherapy group). Seventeen concurrently treated patients did not receive adjuvant chemotherapy (control group). From the comparison of survival curves of these two groups, the following results were obtained. 1) Survival curves of the patients in all stages did not differ significantly between chemotherapy and control groups. 2) Among patients in stage pT3, pT4 and/or N+, survival of the chemotherapy group seemed to have some advantage over that of the control group, but the survival curves did not differ significantly between these two groups. 3) Among patients in N+, survival of the chemotherapy group was far better than that of the usual cases. Review of the literature on adjuvant chemotherapy after cystectomy for bladder tumor revealed the necessity of randomized study to determine whether adjuvant chemotherapy is effective.     

膀胱偶发肿瘤的的诊断与治疗

背景与目的：膀胱偶发肿瘤的国内外报道较少，有必要总结一下膀胱偶发肿瘤的临床特点，以提高膀胱偶发肿瘤的诊治水平。方法：回顾性分析11例膀胱偶发肿瘤的临床资料。常规体检B超发现6例，膀胱镜下置放或拔双J管发现3例，经尿道前列腺电切（TURP）术中发现2例，肿瘤直径0．2～1．5cm。结果：11例均行经尿道膀胱肿瘤电切（TURBT）术，术后病理：乳头状瘤1例，内翻性乳头状瘤2例，乳头状低度恶性倾向的尿路上皮肿瘤3例，低级别的乳头状尿路上皮癌5例。所有膀胱癌患者TURBT术后接受即刻单剂膀胱灌注化疗，术后定期膀胱镜复查。随访半年至10年，复发1例。结论：膀胱偶发肿瘤中膀胱癌多见，但恶性程度低，肿瘤表浅,预后良好，术后复发率低。     

螺旋CT在膀胱肿瘤中的临床应用价值

目的探讨螺旋CT在膀胱肿瘤中的临床应用价值。方法应用螺旋CT对28例经纤维膀胱镜(FC)和病理证实膀胱肿瘤的患者做膀胱平扫及四期增强扫描,并对排泄期图像做多平面重组(MPR)、三维(3D)重建和CT仿真膀胱镜(CTVC)成像。采用盲法与FC及手术结果对照分析。结果螺旋CT轴位、3D和CTVC图像对膀胱癌的检出率分别为92.3％、76.9％和96.2％;CT对肿瘤术前分期的准确性为83.0％。轴位图像能很好地显示肿瘤的侵袭深度;MPR可更直观地观察肿瘤的起源、向周围侵犯的情况及其与输尿管的关系;3D和CTVC均能清楚显示肿瘤的大体形态及其与输尿管开口的关系,CTVC有利于显示<5 mm的肿瘤。结论螺旋CT轴位结合MPR、3D和CTVC图像可以为诊断和治疗膀胱肿瘤提供依据。     

Novel endoscopic diagnosis for bladder cancer

Advances in endoscopic imaging technology may improve sensitivity for the detection of bladder cancer and provide a more complete understanding of the urothelial landscape, and it also may lead to improved short‐term and long‐term cancer control. Fluorescence cystoscopy requires intravesical administration of a photosensitizing agent (5‐aminolevulinic acid or hexaminolevulinate), and imaging with a blue‐light endoscopy system demonstrably improves the detection of papillary and flat bladder lesions compared with conventional white‐light cystoscopy. Prospective phase 3 clinical trials have demonstrated improved diagnostic ability, enhanced tumor resection, and a small but significant reduction in recurrence‐free survival. Optical coherence tomography delineates subsurface microarchitecture information about bladder lesions in real time and has the ability to discriminate between noninvasive and invasive cancers. Narrow‐band imaging may augment white‐light cystoscopy by providing increased contrast between normal and abnormal tissue on the basis of neovascularity. Confocal laser endoscopy has been applied to the urinary tract using thinner probes adapted from use in gastrointestinal malignancies and provides exquisite images at microscopic resolution. More technology is on the horizon that may further enhance our ability to detect and accurately stage bladder tumors and distinguish benign from malignant or dysplastic lesions. Cancer 2015;121:169–78 . © 2014 American Cancer Society.     

Various urinary properties in bladder tumor patients

Urinary electrolytes, pH, urea nitrogen, creatinine, uric acid and osmolarity were measured in patients with bladder tumors and compared with those of a control group. There were 41 bladder tumor patients ranging in age from 29 to 87 (average 64) years with a male:female ratio of 32:9. According to histopathological classification of the bladder tumors, there were 34 transitional cell carcinomas (TCC) (21 G1, 10 G2, 3 G3), four squamous cell carcinomas, two adenocarcinomas and one inverted papilloma. The control group comprised 29 patients ranging in age from 35 to 80 (average 63) years with a male:female ratio of 26:3. Four urine samples were collected from each patient: early morning on the day of admission, just after admission, early morning on the day of return to hospital after temporary discharge, immediately after return to hospital after temporary discharge. The results indicated that the urinary Ca2+ and uric acid values were significantly lower in the bladder tumor group than in the control group. The urinary pH tended to be somewhat higher than in the control group, and the pH values tended to be especially high in the TCC G3 patients. There were differences in the various urinary properties between the TCC G1 and G2 and the TCC G3 patients.     

微小RNA与肿瘤诊断

微小RNA (miRNA)能在转录后水平调节mRNA表达。miRNA与胃肠癌、肺癌、乳腺癌、卵巢癌、前列腺癌、胰腺癌和肝癌等多种肿瘤的发生、发展密切相关,而且很多miRNA在肿瘤中表达水平明显异常。miRNA可作为一种标志物用于多种肿瘤的诊断。     

微小RNA与肿瘤诊断

微小RNA（miRNA）能在转录后水平调节mRNA表达。miRNA与胃肠癌、肺癌、乳腺癌、卵巢癌、前列腺癌、胰腺癌和肝癌等多种肿瘤的发生、发展密切相关,而且很多miRNA在肿瘤中表达水平明显异常。miRNA可作为一种标志物用于多种肿瘤的诊断。     

Vimentin and tumor diagnosis

Vimentin was isolated and purified from the pig eye lens by homogenization, ultracentrifugation, extraction in urea buffer and preparative eletrophoresis. It was identified with SDS-PAGE and rabbit anti-vimentin was raised against the purified vimentin. The specificity of anti-vimentin was examined with immunohistochemical technique and double immune diffusion. Results showed that the vimentin antibody possessed good specificity for mesenchyme-derived cells. Tumor tissue sections from 151 cases were stained with anti-vimentin, anti-keratin, anti-desmin, anti-S-100 protein, anti-Factor-FV III related anti-gen, and anti-lysozyme. Positive staining was obtained in mesenchyme-derived cells, while the epithelial tumor cells did not react with anti-vimentin. It indicated that vimentin anti-body is effective for tumor differential diagnosis in surgical pathology.     

经尿道等离子体双极电切术治疗非肌层浸润膀胱肿瘤疗效分析

目的 评估经尿道等离子体双极电切术(PKRSt)治疗膀胱肿瘤的有效性和安全性.方法 回顾2005年4月至2007年6月完成的经尿道PKRBt手术者30例,男26例,女4例.年龄36～93岁,平均65岁.左侧壁11例,右侧壁13例,三角区及其他部位6例.肿瘤大小0.5～3.1 cm.手术在硬膜外或腰麻下进行,分三段切除肿瘤送病理检查.结果 所有肿瘤均顺利切除,手术时间15～75min,平均手术时间为40 min.无输血病例.2例手术在切除小块组织时出现膀胱穿孔,留置尿管治愈;3例侧壁肿瘤手术时有轻微闭孔内肌反射.2例术前外院病理诊断腺性膀胱炎,术后病理诊断为尿路上皮癌.随访3～26个月,6例复发,5例再次行PKRBt术,1例行根治性切除术.结论 经尿道等离子体双极电切是治疗浅表膀胱肿瘤的有效方法之一,切除侧壁肿瘤及小块组织时仍要特别小心.     

经尿道膀胱肿瘤等离子整块剜除术在膀胱癌治疗中的应用效果

目的 比较经尿道膀胱肿瘤等离子整块剜除术(TeURBT)和传统经尿道膀胱肿瘤电切术(TURBT)在膀胱癌治疗中的应用效果.方法 根据手术方法的不同将76例膀胱癌患者分为TeURBT组(n=36,接受TeURBT治疗)和TURBT组(n=40,接受TURBT治疗).比较两组患者的围手术期指标、磷酸化蛋白激酶B(p-AKT...