尿脱落细胞染色体异常预测浅表性膀胱癌术后复发的临床价值

目的 观察浅表性膀胱癌患者尿脱落细胞染色体的核型异常及其与肿瘤复发的关系.方法 应用双色荧光原位杂交(FISH)技术分析经随访3年以上病理证实的42例复发和24例未复发浅表性膀胱癌患者尿脱落细胞中7号和17号染色体的拷贝数.绿色和红色荧光素探针分别标记7号和17号染色体.结果 7号、17号染色体异倍体率分别为48.5%(32/66)和50.0%(33/66),两者同时异常表达25.8%(17/66).在G2/3膀胱癌中,复发肿瘤17号染色体异倍体率(64.3%)明显高于未复发肿瘤(22.2%,P＜0.05),而G1膀胱癌中,复发与未复发肿瘤7号、17号染色体异倍体率差异均无统计学意义(均P＞0.05).在pTa和Pt1膀胱癌中,未发现肿瘤复发与7号和17号染色体异常有关,但Pt1膀胱癌中,复发肿瘤7号和17号染色体同时异常表达(47.8%)明显高于未复发肿瘤(12.5%,P＜0.05).在14例复发后进展的膀胱癌中,7号和17号染色体异倍体率(78.6%、92.9%)显著高于未进展膀胱癌(42.9%.46.4%,P＜0.05).结论 膀胱癌患者尿脱落细胞染色体的异常有助于判断其术后复发和临床进展.基于FISH技术检测尿脱落细胞有可能成为简便、有效的膀胱癌预后指标之一.

Clinical value of aneusomy of chromosomes in exfoliated urothelial cells to predict the recurrence of superficial bladder cancer after complete transurethral resection

Objective To analyze the chromosomal karyotype aberrations of exfoliated urothelial cells in superficial bladder cancer patients and the correlation thereof to recurrence of carcinoma.Methods Voided urine samples were collected from 42 patients with pathologically confirmed recurrent bladder cancer and 24 bladder cancer patients without pathologically confirmed recurrence,all of which had undergone complete transurethral resection and had been followed up for more than 3 years.Fluorescence in situ hybridization(FISH)was used with Spectrum Green to label the chromosome 7 and Spectrum Red to label the chromosome 17 of the exfoliated uruthelial cells.Resuits The aneuploidy rates of chromosomes 7 and 17 were 48.5%(32/66)and 50.0%(33/66)respectively,and the co-aneuploidy rate of chromosomes 7 and 17 was 25.8%(17/66).In the patients with G2/3 superficial bladder cancer,the aneuploidy rate of chromosomes 17 of those with recurrence was 64.3%.significantly higher than that of patients without recurrence(22.2%,P＜0.05).However,there were not significant difierences in the aneuploidy rates of chromosomes 7 and 17 in the pTa and pT1 superficial bladder cancer patients with or without recurrence(all P＞0.05).however,the co-aneuploidy rate of chromosomes 7 and 17 of the patients with recurrence was 47.8%,significantly hiher than that of the patients without recurrence(12.5%,P＜0.05).F0urteen of the 42 patients with recurrence showed progression,i.e.,with increased grade or stage(≥pT2).The aneuploidy rates of chromosomes 7 and 17 of these 14 patients were 78.6%and 92.9%respectively.both significantly higher than those of the 28 patients without progression(42.9%and 46.4%respectively,both P＜0.05).Conclusion Abnormality in the chromosomes in exfoliated urothelial cells of superficial bladder cancer patients using FISH technique helps predict recurrence and progression of the cancer.