UroVysion 荧光原位杂交技术检测在泌尿系统肿瘤诊断及膀胱癌预后监测中应用的初步探索

doi:10.16150/j.1671-2870.2018.02.008

摘要/Abstract

摘要： 目的：评估UroVysion 荧光原位杂交技术（fluorescence in situ hybridization, FISH）检测（以下简称FISH）在诊断不同部位发生的泌尿系统肿瘤中的灵敏度和特异度,探究其在泌尿系统肿瘤筛查中的应用前景,并初步探讨将其检测结果结合临床病史以监测膀胱癌患者预后的价值。方法：收集368例泌尿外科疑似泌尿系统恶性肿瘤住院患者的新鲜晨尿标本,采用FISH检测,比较其检测结果与临床病理特征间的相关性,分析该检测在不同发生部位泌尿系统肿瘤诊断中的价值,尤其是对于血尿患者的肿瘤筛查以及在膀胱癌随访监测中的临床应用价值。结果：① 采用FISH检测诊断不同发生部位泌尿系统恶性肿瘤（膀胱癌、肾癌、输尿管癌和前列腺癌）时,其对于血尿标本的诊断灵敏度高于非血尿标本(P<0.05）。② 采用FISH检测诊断不同病理分级、分期的泌尿系统肿瘤时,其对于高级别肿瘤的诊断灵敏度和特异度明显高于低级别肿瘤,尤其对于血尿标本呈现出较高的诊断灵敏度（P<0.05）。③在最终确诊为膀胱癌的156例患者中,有45.51%（71/156）的患者在随访中出现肿瘤复发,而FISH监测膀胱癌患者复发的阳性检出率为57.75%（41/71）。④采用FISH法随访监测156例最终确诊为膀胱癌的患者,诊断血尿患者在随访中复发的灵敏度高于有泌尿系统肿瘤病史患者的灵敏度。结论：①FISH检测在泌尿系统肿瘤诊断中具有较高的灵敏度和特异度,且与肿瘤的恶性程度及浸润程度间有一定的相关性,尤其在诊断高级别肌层浸润性膀胱癌中具有重要价值。② FISH检测可用于监测膀胱癌患者的复发及预后,尤其应加强对血尿患者的随访。

关键词: 荧光原位杂交, 泌尿系统肿瘤, 膀胱癌, 血尿, 预后

Abstract: Objective: To assess the value of UroVysion FISH for screening urological malignancy and to explore its potential application in monitoring of recurrence of bladder cancer. Methods: Fresh urine specimens were collected from 368 cases with hematuria and/or history of urological cancer during follow-up. Diagnostic performance of UroVysion FISH for screening urological malignancy was evaluated in accordance with the results of pathology. Further analysis especially in patients with hematuria was conducted to determine the value of UroVysion FISH for detecting urological malignancy as well as for monitoring recurrence of bladder cancer. Results: ① The sensitivity of UroVysion FISH for detecting urological malignancy (bladder cancer, renal cancer, carcinoma of ureter, prostatic cancer) in patients with hematuria was superior to that without hematuria(P<0.005). ② Results of UroVysion Fish were closely related to tumor grade of urological malignancy. The sensitivity and specificity of UroVysion Fish for diagnosing high-stage tumor were higher than those of low-stage, especially in patients with hematuria. ③ A total of 45.51%(71/156) patients who eventually diagnosed as bladder cancer had cancer recurrence, and 57.75%(41/71) of them could be predicted according to the results of UroVysion Fish. ④ Results of FISH for bladder cancer follow-up in patients with hematuria showed higher sensitivity than in patients with history of urological malignancy. Conclusions: UroVysion FISH has high sensitivity and specificity for detecting urological malignancy, and the results are strongly relevant to tumor malignancy and invasion. UroVysion FISH is valuable for monitoring recurrence of bladder cancer, especially in patients with hematuria.

Key words: Fluorescence in situ hybridization, Urological malignancy, Bladder cancer, Hematuria, Prognosis

中图分类号:

R737.1

徐苓, 王根发, 张良. UroVysion 荧光原位杂交技术检测在泌尿系统肿瘤诊断及膀胱癌预后监测中应用的初步探索[J]. 诊断学理论与实践, 2018, 17(02): 159-164.

XU Ling, WANG Genfa, ZHANG Liang. Diagnostic value of UroVysion FISH for detecting urological malignancy and its use in monitoring recurrence of bladder cancer[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(02): 159-164.

参考文献

[1] Griffiths TR, Action on Bladder Cancer. Current perspectives in bladder cancer management[J]. Int J Clin Pract,2013,67(5):435-448.
[2] Crawford JM.The origins of bladder cancer[J]. Lab Invest,2008,88(7):686-693.
[3] Grossman HB, Gomella L, Fradet Y, et al.A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer[J]. J Urol,2007,178(1):62-67.
[4] Sullivan PS, Nooraie F, Sanchez H, et al.Comparison of ImmunoCyt, UroVysion, and urine cytology in detection of recurrent urothelial carcinoma: a "split-sample" study[J]. Cancer,2009,117(3):167-173.
[5] Siegel RL, Miller KD, Jemal A.Cancer statistics, 2016[J]. CA Cancer J Clin,2016,66(1):7-30.
[6] Fadl-Elmula I, Gorunova L, Mandahl N, et al.Cytogene-tic analysis of upper urinary tract transitional cell carcinomas[J]. Cancer Genet Cytogenet,1999 ,115(2):123-127.
[7] Caraway NP, Khanna A, Fernandez RL, et al.Fluorescence in situ hybridization for detecting urothelial carcinoma: a clinicopathologic study[J]. Cancer Cytopathol,2010,118(5):259-268.
[8] Hajdinjak T.UroVysion FISH test for detecting urothelial cancers: meta-analysis of diagnostic accuracy and comparison with urinary cytology testing[J]. Urol Oncol,2008, 26(6):646-651.
[9] Dimashkieh H, Wolff DJ, Smith TM, et al.Evaluation of urovysion and cytology for bladder cancer detection: a study of 1835 paired urine samples with clinical and histologic correlation[J]. Cancer Cytopathol,2013,121(10):591-597.
[10] Schmitz-Dräger BJ, Droller M, Lokeshwar VB, et al.Molecular markers for bladder cancer screening, early diagnosis, and surveillance: the WHO/ICUD consensus[J]. Urol Int,2015,94(1):1-24.
[11] Karaoglu I, van der Heijden AG, Witjes JA. The role of urine markers, white light cystoscopy and fluorescence cystoscopy in recurrence, progression and follow-up of non-muscle invasive bladder cancer[J]. World J Urol, 2013,32(3):651-659.
[12] Black PC, Brown GA, Dinney CP.Molecular markers of urothelial cancer and their use in the monitoring of superficial urothelial cancer[J]. J Clin Oncol,2006,24(35): 5528-5535.
[13] Gudjónsson S, Isfoss BL, Hansson K, et al.The value of the UroVysion assay for surveillance of non-muscle-invasive bladder cancer[J]. Eur Urol,2008,54(2):402-408.
[14] Ather MH, Nazim SM.New and contemporary markers of prognosis in nonmuscle invasive urothelial cancer[J]. Korean J Urol,2015,56(8):553-564.

[1]	谢吻, 梁怀予, 董磊, 袁菲, 王朝夫, 郭滟. 胰腺导管腺癌重要驱动基因突变与临床病理特征、预后间相关性的分析[J]. 诊断学理论与实践, 2022, 21(05): 581-587.
[2]	李蕾, 袁菲, 王朝夫, 许海敏, 王婷. 101例壶腹部腺癌临床病理及预后因素分析[J]. 诊断学理论与实践, 2022, 21(03): 355-361.
[3]	陈曦, 杜鹃. 多发性骨髓瘤预后风险的精准评估[J]. 诊断学理论与实践, 2021, 20(06): 522-528.
[4]	冯国伟, 张晓娟, 郭睿, 关哲, 王越. 治疗前¹⁸F-FDG PET/CT显像对结外NK/T细胞淋巴瘤的预后判断价值[J]. 诊断学理论与实践, 2021, 20(06): 533-539.
[5]	梁亚丽, 赵海港, 项广宇. 应激性高血糖比值预测急性缺血性脑卒中患者溶栓治疗后1年不良预后的价值[J]. 诊断学理论与实践, 2021, 20(06): 562-566.
[6]	冯明洋, 丁叶舟, 赵青青, 赵钢德, 娄世珂, 郑超, 孙学华, 刘柯慧, 林兰意, 谢青, 郑岚, 王晖. 肝衰竭患者中医证型与西医肝衰竭分期之间的关系观察[J]. 诊断学理论与实践, 2021, 20(04): 391-395.
[7]	芮文斌, 徐达, 祝宇, 吴瑜璇, 王浩飞, 汪成合, 袁菲. 缺氧诱导因子1α在乳头状肾细胞癌中的表达及其与预后的关系[J]. 诊断学理论与实践, 2021, 20(03): 265-370.
[8]	刘彤, 王鑫. 心房颤动预后不良风险的评估策略[J]. 诊断学理论与实践, 2020, 19(06): 555-558.
[9]	张中文, 左祥荣, 郑绪辉, 曹权, 李新立, 李艳秀. 3q26 rs12696304基因多态性与中国南方汉族老年人群急性心力衰竭患者一年预后间的关系研究[J]. 诊断学理论与实践, 2020, 19(06): 565-571.
[10]	杜海磊, 陈聆, 罗方秀, 李勇, 程齐俭, 朱良纲, 杭钧彪. Beclin-1和Bcl-2表达与非小细胞肺癌患者病理特征及预后间关系的研究[J]. 诊断学理论与实践, 2020, 19(03): 258-263.
[11]	徐兆平, 王浩飞. ZNF692基因在肾透明细胞癌中的表达及其与患者预后间关系的研究[J]. 诊断学理论与实践, 2020, 19(03): 292-296.
[12]	侯亚楠, 禤立平, 赵志云, 李勉, 陈宇红, 戴蒙, 徐敏, 毕宇芳, 王卫庆, 高金丽. 上海社区中老年人群血尿酸/肌酐比值与代谢综合征关联性的流行病学调查[J]. 诊断学理论与实践, 2019, 18(1): 44-50.
[13]	杜云志, 冯菁华, 常春康. 二代测序技术在骨髓增生异常综合征临床诊断和治疗决策中的应用进展[J]. 诊断学理论与实践, 2019, 18(06): 685-671.
[14]	田明明, 吴涛, 薛锋, 汉英, 张丽萍, 王存邦, 白海. Ph（+）急性淋巴细胞白血病伴骨髓坏死一例[J]. 诊断学理论与实践, 2019, 18(05): 585-587.
[15]	张玉奇, 鲍圣芳. 血管环的产前超声心动图诊断及预后评估[J]. 诊断学理论与实践, 2019, 18(05): 487-490.