肿瘤细胞在骨髓中播散的自动显微图像研究

AUTOMATED MICROSCOPIC IMAGE ANALYSIS FOR DETECTION OF TUMOR CELL DISSEMINATION IN BONE MARROW

泌尿系肿瘤患者骨髓中散在的微转移肿瘤细胞监测。方法 :术前采集肾癌、前列腺癌和膀胱癌共 144例病人的骨髓标本并收集相关临床资料 ,应用细胞角蛋白的免疫细胞化学方法进行检测 ,并将结果与 TNMG分期 (级 )进行相关分析。结果 :肾癌阳性率为 35 .71% ,前列腺癌为 2 5 % ,膀胱癌为 42 .46 % ;除前列腺癌 G3/ 4组阳性率 (4 5 % )明显高于 G1/2组 (14% )外 (P =0 .0 2 ) ,其余病例各组间的阳性率均无显著性差异。结论 :肿瘤细胞的分化程度可能与其离开原发灶发生播散的能力有关 ,免疫细胞化学方法可作为检测骨髓中隐蔽的微转移肿瘤细胞的标准方法 ,该指标乃为一个独立的危险因素 ,对病人预后评估和治疗方法的选择与确定有指导意义。

Objective:To detect individual tumour cells of micrometastases in the bone marrow of patients with urologic carcinoma Methods:Prior to operation,bone marrow was aspirated in all 144 patients with carcinoma of kidney(RCC),prostate(PC),and bladder(BC) We used an immunocytochemical cytokeratins assay to allow the identification of individual tumour cells disseminated to bone marrow We also wanted to find out whether there was any correlation between the incidence of tumor cell detection and the TNM classification and tumor differentiation grading Results:Tumour cells in the bone marrow were detected in 35 71% of the patients with RCC;in 25% of the patients with PC; in 42 46% with BC The positive rates of G3/4 patients with PC(45%) was significantly higher than those(14%) of G1/2 patients (P=0 02) No statistically significant differences were found in positive rates between the rest of another group Conclusion:Differentiation of tumour cells may be related to dissemination An immunocytochemical staining assay for cytokeratins must be extremely sensitive standard method for micrometastic detection It is an independent risk factor and could have a substantial clinical impact on the prognosis and optimal therapy for patients with cancer