17号染色体数目异常在预测浅表性膀胱癌复发中的研究

目的：探讨17号染色体数目异常在预测浅表性膀胱癌复发中的作用。方法：取随访3年经病理检查证实的25例复发性和15例未复发性浅表性膀胱癌石蜡切片标本,应用17号染色体特异性荧光探针行荧光原位杂交（Fluorescence in situ hybridization．FISH）分析。结果：复发性膀胱癌中17号染色体数目异常19例,明显高于未复发组3例异常患者（P〈0．05）．6例单倍体全部复发,17号染色体数目异常与膀胱癌的进展无相关性（P〉0．05）,其无病生存时间较17号染色体正常患者明显缩短（P〈0．05）．17号染色体数目异常者复发的可能性是17号染色体正常的3．07倍。结论：17号染色体数日异常与浅表性膀胱癌复发有关,可以作为预测浅表性膀胱癌术后复发的有用指标。     

C-erbB-2基因与HER2蛋白用于浅表性膀胱癌复发的研究

目的探讨C-erbB-2基因扩增和HER2蛋白阳性表达与浅表性膀胱癌的术后复发和肿瘤分级、临床分期的关系。方法用荧光原位杂交技术（FISH）和免疫组化（IHC）法,分析经病理证实、随访3年以上的20例复发性膀胱肿瘤与20例未复发膀胱肿瘤的C-erbB-2基因扩增与HER2蛋白表达情况。结果在复发的膀胱癌组中,HER2蛋白表达阳性的共有7例;未复发组中1例HER2蛋白表达阳性,复发组明显高于未复发组;结论HER2蛋白的阳性表达与膀胱癌的复发具有相关性,而与肿瘤的分级、分期无统计学意义。C-erbB-2基因与膀胱癌的复发、分级、分期以及与HER2蛋白的过表达无相关关系。     

浅表性膀胱癌复发原因分析

浅表性膀胱癌是一种复发率极高的肿瘤 ,本文就可能影响膀胱癌复发的肿瘤自身因素及人为因素在膀胱癌复发中所起的影响及地位进行了综述     

染色体荧光原位杂交技术研究小片段和复杂的染色体易位

染色体之间的平衡易位，当片段很小或淑及色体数目多时，显微镜下容易漏诊，或难以准确断裂点。本文报告了用染色体荧光原位杂交（ＦＩＳＨ）的实验技术结合常规Ｇ显带、高分辨Ｇ显带技术诊断了２例难辩认的当色易位。本研究表明，ＦＩＳＨ技术结合细胞遗传学核型地于检测小片段难辨认或复杂的染色体易位是非常有帮助的。     

膀胱癌复发与染色体畸变关系的研究进展

膀胱移行细胞癌手术后复发是临床上引人关注的问题。多数观点认为膀胱癌复发的原因是由于手术中癌细胞种植或原位复发。现在的研究证明，膀胱癌复发与染色体畸变及相应的基因变化有关。是由确定的分子事件促发的。本文对这方面的研究进行综述。     

染色体荧光原位杂交技术研究小片段和复杂的染色体易位

染色体之间的平衡易位，当片段很小或涉及染色体数目多时，显微镜下容易漏诊，或难以准确判定断裂点。本文报告了用染色体荧光原位杂交（ＦＩＳＨ）的实验技术结合常规Ｇ显带、高分辨Ｇ显带技术诊断了２例难辨认的染色体易位。本研究表明，ＦＩＳＨ技术结合细胞遗传学核型分析，对于检测小片段难辨认或复杂的染色体易位是非常有帮助的。     

膀胱癌复发与染色体畸变关系的研究进展

膀胱移行细胞癌手术后复发是临床上引人关注的问题。多数观点认为膀胱癌复发的原因是由于手术中癌细胞种植或原位复发。现在的研究证明 ,膀胱癌复发与染色体畸变及相应的基因变化有关 ,是由确定的分子事件促发的。本文对这方面的研究进行综述。     

改良丝裂霉素C灌注法预防初发浅表性膀胱癌复发

目的改进丝裂霉素C膀胱灌注治疗方案，提高其预防浅表性膀胱癌电切术后复发的疗效。方法62例初发浅表性膀胱癌患者随机分为常规组和改良组。术后随访5年。结果肿瘤5年复发率常规组为55．2％，改良组为32．8％，经log-rank检验，差异有统计学意义（P〈0．05）。出现膀胱不良反应常规组10例，改良组12例，经χ^2检验无统计学意义（P〉0．05）。结论改良丝裂霉素C膀胱灌注化疗可以有效预防初发浅表性膀胱癌电切术后复发。     

介绍一种应用双色荧光复位杂交检测人精子染色体数目异常的技术

研究人类精子染色体常用的方法有两种,一种是用人类精子体外穿透金黄地鼠卵[1],这个方法虽然可以观察到精子的全部染色体组成,但由于这个方法操作复杂,十分耗时,且只适合于可以穿透金黄地鼠卵的精子,因而在临床上受到很大限制,推广起来也很困难.     

榄香烯预防浅表性膀胱癌术后复发的临床观察

目的　观察榄香烯膀胱内灌注预防浅表性膀胱癌术后复发的疗效及毒副反应。　方法　膀胱癌术后患者123例,均为浅表性膀胱癌(T1 ),其中移行细胞癌Ⅰ级37例,Ⅱ级73例,Ⅲ级13例。随机分为2组,榄香烯治疗组63例,丝裂霉素对照组60例,分别采用榄香烯注射液及丝裂霉素C行膀胱内灌注,观察2组肿瘤复发情况、毒副反应及治疗前后血NK细胞活性。　结果　榄香烯组平均随访19. 7个月,复发5例,复发率7. 9%;灌注后出现膀胱刺激症状2例(3. 2% ),无严重血尿及尿道狭窄;患者治疗前血NK细胞活性为(20±2)%,治疗后为(28±2)%,治疗前后比较差异有统计学意义(P<0. 05)。丝裂霉素组平均随访19. 4个月,复发15例,复发率为25. 0%;灌注后出现膀胱刺激症状11例(18. 3% ),严重血尿3例(5. 0% ),尿道狭窄1例(1. 7% )。2组术后复发率、毒副反应发生率差异有统计学意义(P<0. 05)。　结论　榄香烯注射液膀胱灌注预防浅表性膀胱癌术后复发有良好疗效,毒副反应少,是一种值得推广的新方法。     

Analysis of factors predicting intravesical recurrence of superficial transitional cell carcinoma of the bladder without concomitant carcinoma in situ

BACKGROUND: The objective of this study was to investigate risk factors for intravesical recurrence in patients with superficial bladder cancer without concomitant carcinoma in situ (CIS). METHODS: In this series, we analyzed data from patients with newly diagnosed superficial Ta or T1 transitional cell carcinoma (TCC) of the bladder without concomitant CIS who underwent complete transurethral resection (TUR) without any adjuvant intravesical instillation therapies. Multivariate analysis was used to determine significant risk factors affecting intravesical recurrence after TUR. Differences in clinicopathological features between primary and recurrent tumors were also characterized. RESULTS: Among 341 patients undergoing TUR of Ta or T1 bladder cancer, 187 diagnosed as having concomitant CIS and/or treated with adjuvant intravesical therapy were excluded, and the remaining 154 were evaluated. Intravesical recurrence was detected in 64 of the 154 patients, showing a 5-year recurrence-free survival rate of 58.3%. Among several factors examined, only tumor size was significantly associated with intravesical recurrence. Multivariate analysis identified tumor size as an independent predictor for intravesical recurrence irrespective of other parameters including age, gender, multiplicity, growth pattern, grade and stage. Recurrent tumors were significantly smaller and of a lower grade and lower stage than primary tumors, despite the absence of differences in growth pattern and the multiplicity between them. CONCLUSIONS: These findings suggest that primary tumor size could be used as a potential risk factor for predicting intravesical recurrence following TUR of superficial TCC of the bladder without concomitant CIS, and that the pathological characteristics of recurrent tumors are more favorable than those of primary tumors.     

荧光原位杂交技术在膀胱尿路上皮癌诊断中的应用价值

目的:评估荧光原位杂交技术(FISH)在膀胱尿路上皮癌诊断中的应用价值。方法:收集60例疑似膀胱癌的血尿患者的尿液标本,分别作尿细胞学检测和荧光原位杂交分析。20例正常人尿液标本,用于建立FISH阀值,作为阳性判断的标准。结果:细胞学和FISH的总敏感性分别为42.0%、82.2%,特异性分别为:93.3%、86.7%。细胞学和FISH在低级别及非肌层浸润性肿瘤等敏感性的均差异有统计学意义(P<0.05)。结论:FISH技术能明显提高膀胱尿路上皮癌的检出率,尤其是早期和低级别病变,可以成为筛查膀胱尿路上皮癌的一种新的无创性检查方法。     

表浅膀胱肿瘤电切术后膀胱内药物灌注预防肿瘤复发的临床观察

目的 观察表浅膀胱肿瘤电切术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的疗效和安全性.方法 回顾性分析我科2007年2月至2009年10月间收治的130例表浅膀胱肿瘤患者的临床资料,所有患者均行经尿道膀胱肿瘤电切和术后膀胱内灌注丝裂霉素或吡柔比星,其中术后膀胱内灌注丝裂霉素70例,吡柔比星60例.观察术后1年肿瘤复发和灌注药物的副作用.结果 ①术后膀胱内灌注丝裂霉素和吡柔比星的1年复发率分别为11.4%（8/70）和16.7%（10/60）（P＞0.05）.在丝裂霉素组,病理分级G1、G2、G3级肿瘤1年复发率分别为12.2%、8%和25%,它们之间无显著差异（P＞0.05）;在吡柔比星组,病理分级G1、G2、G3级肿瘤1年复发率分别为4%、12.5%和54.5%,其中G3级肿瘤复发率明显高于G1和G2级肿瘤（P＜0.05）.②130例患者中,进行即刻膀胱内药物灌注（24h内）和非即刻灌注的1年复发率分别为4%（1/25）和16.2%（17/105）,两者之间有显著性差异（P＜0.05）.③灌注丝裂霉素和吡柔比星后全身副作用发生率分别为18.5% 和 1.5%（P＜0.05）,局部副作用发生率分别为4.3% 和 33.3%（P＜0.05）.结论 术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的效果无显著性差异,但G3级肿瘤的复发率高于G1和G2级肿瘤,对其灌注方案有待进一步研究;术后即刻膀胱内药物灌注可有效降低肿瘤1年复发率,值得推广;术后膀胱内灌注丝裂霉素和吡柔比星的副作用在全身和局部发生率不同,但均可耐受;由于观察时间短和例数有限,观察结果有待进一步研究.     

Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer

PURPOSE: The UroVysion fluorescence in situ hybridization assay (UroVysion Bladder Cancer Recurrence Kit, Vysis, Inc., Downers Grove, Illinois) is a multi-target assay that detects aneuploidy of chromosomes 3, 7 and 17, and loss of the 9p21 band in exfoliated cells in urine from patients with transitional cell carcinoma. We performed 2 multicenter trials. In 1 trial we compared the sensitivity of the FISH assay to the BTA Stat test (Bion Scientific, Redmond, Washington) and voided cytology in the detection of transitional cell carcinoma. In a separate study of healthy volunteers and patients with other (nontransitional cell carcinoma) conditions we determined the specificity of the FISH assay. MATERIALS AND METHODS: A total of 176 patients with transitional cell carcinoma in the previous 9 months provided voided urine before cystoscopy. Each specimen was split, preserved and shipped to a central laboratory where all 3 tests were performed. All sites were blinded to results. Sensitivity calculations were based on central pathology review of resected tissue. Specificity was determined by testing 275 volunteers who were healthy and with nontransitional cell carcinoma conditions. RESULTS: The 21 sites enrolled 176 patients with a history of transitional cell carcinoma, with 62 recurrences while undergoing surveillance. Overall sensitivities (with 95% CI) were FISH 71% (95% CI 58 to 82), BTA Stat test 50% (37 to 63) and cytology 26% (16 to 39). FISH was negative in 260 of the 275 healthy volunteers or patients with no history of transitional cell carcinoma (specificity 94.5%). CONCLUSIONS: Sensitivity of the FISH assay is superior to that of cytology and at least equivalent to the BTA Stat test in detecting recurrent transitional cell carcinoma. Its specificity approaches that of cytology. Further testing of its clinical use is warranted.     

Predictive value of N-acetylglucosaminyltransferase-V for superficial bladder cancer recurrence

PURPOSE: GnT-V is an enzyme that catalyzes beta1-6 branching of N-acetylglucosamine on asparagine (N)-linked oligosaccharides of cell proteins. GnT-V expression has been closely related to malignant potentials in colon cancer, brain cancer and hepatocellular carcinoma. We determined whether GnT-V expression is predictive of superficial bladder cancer recurrence. MATERIALS AND METHODS: The cohort comprised 60 consecutive patients with first time superficial bladder cancer treated with transurethral resection. None of the patients received prophylactic intravesical therapy until recurrence. Paraffin embedded tumor specimens were immunohistochemically examined by the avidin-biotin peroxidase method using monoclonal antibody against GnT-V. Kaplan-Meier survival curves were generated to determine disease-free survival. Univariate and multivariate analyses were done to compare GnT-V expression to other clinical and pathological variables. RESULTS: GnT-V expression correlated inversely with tumor grade and stage. The positive incidence of GnT-V in G1 to G3 tumors was 7 of 9 (78%), 21 of 43 (49%) and 3 of 8 (38%), respectively. GnT-V was positive in 26 of 44 cases of pTa (60%) and in 5 of 16 of pT1 (31%) disease. The 31 patients with positive GnT-V expression had significantly higher disease-free survival than the 29 with negative GnT-V expression (log rank test p = 0.0034). Multivariate analysis revealed that patient age, pT, grade and negative GnT-V expression were independent predictors of recurrence (p = 0.015, 0.001, 0.019 and 0.011, respectively). CONCLUSIONS: Immunohistochemical detection of GnT-V is an independent predictor of superficial bladder cancer recurrence.     

表柔比星灌注预防浅表性膀胱癌术后复发

目的 评价表柔比星(EPI)膀胱内灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法 对63例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术(TuRBt)或膀胱部分切除术，术后定期应用EPl30mg(40mL)作膀胱内灌注，每周1次，共8次，以后每月1次，共1年。每次药物在膀胱内保留l小时。结果 经7～28月随访，平均15月，复发4例，复发率为6.3％，未见全身性药物不良反应，仅5例出现轻度膀胱刺激症状。结论 EPI膀胱内灌注预防浅表性膀胱癌术后复发疗效满意，副作用轻，耐受性良好。     

Management of superficial bladder cancer in Victoria: 1990 and 1995

BACKGROUND: A retrospective survey of medical practitioners was undertaken to describe the tumour characteristics, management and outcomes of all superficial bladder cancers newly diagnosed in 1990 and in 1995 in Victoria. METHODS: Cases were identified from the population cancer registry. The survey was conducted in 1999 and the cohort followed up until 2000 to obtain at least 5 years of follow-up data on all patients, in particular to identify recurrence of tumour as assessed at surveillance cystoscopy and progression to muscle invasive cancer. RESULTS: Tumour recurrence was observed in 390/610 patients (63.9%), of whom 56.9% had their recurrence noted at the first check cystoscopy. Ultimately 43 (6.3%) of patients progressed to invasive disease, with this subgroup demonstrating 5-year overall survival of 35% (95% confidence interval (CI) 21-49%). Ultimately survival was proportional to the extent of tumour invasion, being greater in low-risk patients (76%, 95% CI 72-80%, mucosal disease only) than in high-risk patients (46%, 95% CI 36-56%, lamina propria invasion noted at diagnosis). CONCLUSIONS: In low-risk subgroups of patients with superficial transitional cell carcinoma, the frequency of surveillance cystoscopy may be able to be reduced to levels in accordance with established European guidelines without a likely impact on patient survival. Where progression to muscle invasive disease does ensue, more aggressive management may be warranted in order to try to improve survival.     

Use of a multitarget fluorescence in situ hybridization assay to diagnose bladder cancer in patients with hematuria

PURPOSE: We evaluated the multitarget UroVysion fluorescence in situ hybridization assay for the diagnosis of bladder cancer in patients with hematuria and no history of bladder cancer. MATERIALS AND METHODS: A multicenter, blinded trial was performed to compare the sensitivity of the fluorescence in situ hybridization assay to that of voided cytology in patients with gross or microscopic hematuria. Confirmation of hematuria was required. Voided urine was sent to a central laboratory for each study before cystoscopy. Suspicious lesions on cystoscopy were biopsied or resected. A centrally reviewed histopathological interpretation was used to confirm cancer and assign grade and stage. RESULTS: A total of 497 patients were enrolled at 23 centers and in 473 (95.2%) fluorescence in situ hybridization and cytology results were interpretable. Bladder cancer was diagnosed histologically in 50 patients (10.1%) and ureteral cancer was diagnosed in 1. Fluorescence in situ hybridization assay detected 69% of cases and cytology detected 38% (95% CI 25 to 52). When low grade, low stage (TaG1) tumors were excluded, fluorescence in situ hybridization detected 25 of 30 cancers (84%), while cytology detected only 15 (50%). Of 265 current or past smokers with hematuria and positive fluorescence in situ hybridization assay findings bladder cancer was detected in 65% with a history of greater than 40 pack-years compared to 13.6% to 24.2% in those with no, less than a 20 or a 20 to 40-pack-year smoking history. CONCLUSIONS: The UroVysion fluorescence in situ hybridization assay is significantly more sensitive than voided cytology for detecting bladder cancer in patients evaluated for gross or microscopic hematuria for all grades and stages. Based on these data UroVysion was approved by the Food and Drug Administration for use in patients with hematuria.