循环肿瘤细胞核型对非肌层浸润性膀胱癌预后的预测价值

Predictive value of karyotype of circulating tumor cells in the prognosis of non-muscle invasive bladder cancer

目的:探究外周血中循环肿瘤细胞(circulating tumor cell,CTC)和循环肿瘤细胞核型对非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)患者预后的预测作用。方法:选取2018年5月至2019年5月于承德医学院附属医院首次诊治的109例患者临床资料,其中NMIBC组58例、良性病变组51例。采用差相富集和免疫荧光染色-染色体荧光原位杂交(SE-iFISH)技术行CTC鉴定及核型分析,以患者CTC三倍体数目≥60%为三倍体组,数目<60%为非三倍体组,并行生存和预后分析。结果:NMIBC组患者的CTC阳性率为81.0%(47/58),显著高于良性病变组的9.8%(5/51)。Kaplan-Meier法和Log-rank法分析显示,术前、术后三倍体组患者的无病生存(disease-free survival,DFS)期明显短于非三倍体组(P<0.001),术后CTC阳性患者的DFS短于CTC阴性患者(P<0.05)。行Cox比例风险回归模型多因素分析显示术前、术后CTC核型是影响NMIBC患者预后的独立危险因素。结论:术前、术后监测CTC和CTC核型对NMIBC患者具有预测作用,CTC核型是影响预后的独立因素。

Objective:To explore the predictive effect of circulating tumor cells(CTCs)and CTC karyotypes in the peripheral blood on the prognosis of patients with non-muscle invasive bladder cancer(NMIBC).Methods:The clinical data of 109 patients who initially visited Affili-ated Hospital of Chengde Medical College from May 2018 to May 2019 were selected,including 58 patients in the NMIBC group and 51 pa-tients in the benign lesion group.The CTCs and the karyotypes were identified using differential enrichment and subtraction enrichment and immunostaining-fluorescence in situ hybridization(SE-iFISH)techniques.Patients with≥60%CTC triploidy were considered as triploid group and those with<60%as non-triploid group.The data of patients were analyzed for survival and prognosis.Results:The CTC positivity rate of the patients in the NMIBC group was 81.0%(47/58),which was significantly higher than that of the 9.8%(5/51)in the benign lesion group.Kaplan–Meier and Log-rank analyses showed that the disease-free survival(DFS)was significantly shorter in the pre-and postoperat-ive triploid group than that in the non-triploid group(P<0.001)and in the postoperative patients with CTC than that in those without CTC(P<0.05).A multifactorial analysis of the Cox proportional risk regression model showed that preoperative and postoperative CTC karyotypes were the in dependent risk factors affecting the prognosis of patients with NMIBC.Conclusions:Pre-and postoperative monitoring of CTC and CTC karyotype are predictive of NMIBC,and CTC karyotype is an independent factor affecting prognosis.