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

Diagnostic value of UroVysion FISH for detecting urological malignancy and its use in monitoring recurrence of bladder cancer

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:(1)FISH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。

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 lowstage, 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.