经尿道膀胱肿瘤内镜下粘膜剥离术对患者循环肿瘤细胞的影响

The effect of endoscopic mucosal dissection of transurethral bladder tumor on circulating tumor cells in patients

目的:探讨经尿道膀胱肿瘤内镜下粘膜剥离术对患者循环肿瘤细胞数量的影响。方法:入组38例非肌层浸润型膀胱肿瘤患者,分为经尿道膀胱肿瘤内镜粘膜下剥离术(bladder tumor-endoscopic submucosal dissection,BT-ESD)组及传统经尿道膀胱肿瘤电切术(conventional transurethral resection of bladder tumor,cTURBT)组,留取术前及术后患者外周静脉血标本,应用Cyttel^(TM)-CTC平台检测技术(即阴性富集技术结合免疫荧光原位杂交法)检测标本的循环肿瘤细胞(circulating tumor cells,CTCs)数量,分析两种术式围手术期外周血中CTCs计数的差异。结果:BT-ESD组患者术前及术后外周血CTCs计数差异无统计学意义(P=0.712);cTURBT组患者术后外周血循环CTCs计数较术前显著升高(P<0.001);术后外周血循环肿瘤细胞计数在cTURBT组明显高于BT-ESD组(P<0.001);cTURBT组患者术后外周血CTCs计数(P=0.002)及围手术期外周血CTCs数量变化(P=0.002)与膀胱肿瘤复发密切相关。结论:与传统经尿道膀胱肿瘤电切术相比,经尿道膀胱肿瘤内镜粘膜下剥离术不会显著增加循环肿瘤细胞数量。

Objective:To investigate the effect of transurethral bladder tumor endoscopic mucosal dissection on the number of circulating tumor cells(CTCs)in patients.Methods:Collected patients(19 cases)of transurethral bladder tumor-endoscopic submucosal dissection(BT-ESD)and conventional transurethral resection of bladder tumor(cTURBT)(19 cases).Peripheral venous blood samples were collected before and during the operation.Cyttel⁃TM-CTC platform detection technology(negative enrichment technology combined with immunofluorescence in situ hybridization)was performed to analyze the CTCs number in the peripheral blood of the patients.CTCs number were compared before and post operation during the BT-ESD and cTURBT groups.Results:There was no significant difference in the peripheral blood circulating tumor cell counts in the BT-ESD group before and after surgery(P=0.712);The peripheral blood circulating tumor cell counts in the cTURBT group were significantly higher than that in cTURBT group(P<0.001)and BT-ESD group(P<0.001)before surgery(P<0.001);The postoperative CTCs number and perioperative CTCs number change were significantly correlated with bladder tumor recurrent in the cTURBT group(P=0.002,P=0.001).Conclusion:Transurethral bladder tumors endoscopic submucosal dissection approach does not increase the perioperative CTCs number.