联合检测尿核基质蛋白22和尿脱落细胞在监测膀胱癌术后复发中的临床价值

Clinical value of combined use of nuclear matrix protein 22 in urine and urine cytology for monitoring of recurrent bladder cancer

目的探究联合检测尿脱落细胞和尿核基质蛋白22(NMP22)在监测膀胱癌术后复发中的临床应用价值。方法对我院2017年10月至2022年3月收治的106例膀胱癌手术后患者行荧光膀胱镜检查,检查前分别留取尿液样本行NMP22和尿脱落细胞检测;以荧光膀胱镜检查和病理结果为金标准,评价单独检测与联合检测NMP22和尿脱落细胞在诊断膀胱癌复发中的敏感性、特异性、准确性、阳性率和癌检出率,以及在不同分期、分级肿瘤中的阳性检出率。结果单独检测NMP22和尿脱落细胞诊断膀胱癌复发的敏感性分别为60.78%和50.98%,特异性分别为78.18%和87.27%,准确性均为69.81%,而联合检测的敏感性高达92.16%、特异性为74.55%、准确性升至83.02%。联合检测NMP22和尿脱落细胞的阳性率(57.55%)、癌检出率(44.34%)均高于单独检测NMP22的阳性率(40.57%)、癌检出率(29.25%)以及单独检测尿脱落细胞的阳性率(31.13%)、癌检出率(24.53%)。在Ta期和G1级肿瘤中,联合检测的阳性率明显高于单独检测尿脱落细胞的阳性率(P<0.05);在T1期肿瘤中,联合检测的阳性率明显高于单独检测NMP22的阳性率(P<0.05);在G2级肿瘤中,联合检测的阳性率明显高于单独检测NMP22和单独检测尿脱落细胞的阳性率(P<0.05)。结论联合检测NMP22和尿脱落细胞可以明显提高诊断膀胱癌复发的敏感性、准确性、阳性率和癌检出率,提高在Ta、T1期和G1、G2级肿瘤中的检出阳性率,可在行膀胱镜复查前为膀胱癌患者提供更充分、全面及准确的评估,具有一定的临床意义。

Objective To evaluate the clinical value of combined use of urinary nuclear matrix protein 22(NMP22)and urine cytology in monitoring postoperative recurrence of bladder cancer.Methods From October 2017 to March 2022,106 postoperative bladder cancer patients admitted to our hospital were examined by fluorescence cystoscopy.Urine samples for NMP22 test and cytology test were collected prior to fluorescence cystoscopy.Taking fluorescence cystoscopy and pathology as gold standard,the sensitivity,specificity,accuracy,positive rate and cancer detection rate of NMP22,urine cytology,and combined use of NMP22 and urine cytology in the detection of recurrent bladder cancer,as well as their positive rate in different stages and grades were determined.Results The sensitivity of NMP22 test alone and urine cytology test alone for diagnosing bladder cancer recurrence were 60.78%and 50.98%,respectively,and the specificity were 78.18%and 87.27%,respectively,and the accuracy were both 69.81%.The sensitivity of combined use of NMP22 and urine cytology for diagnosing bladder cancer recurrence was 92.16%,the specificity was 74.55%,and the accuracy was 83.02%.The positive rate(57.55%)and cancer detection rate(44.34%)of combined use NMP22 and urine cytology were significantly higher than those of single use of NMP22(40.57%and 29.25%)and urine cytology(31.13%and 24.53%).The positive rate of combined use of NMP22 and urine cytology was significantly higher than that of urine cytology test alone in Ta and G 1 tumors(P<0.05),and significantly higher than that of NMP22 test alone in T 1 tumors(P<0.05),and also significantly higher than that of NMP22 test alone and urine cytology test alone in G 2 tumors(P<0.05).Conclusions Combined use of NMP22 and urine cytology can significantly improve the diagnostic sensitivity,accuracy,positive rate and cancer detection rate of recurrent bladder cancer,and increase the positive rate in Ta,T 1 stage and G 1,G 2 grade tumors.It provides more sufficient,comprehensive and accurate preoperative evaluation with important clinical significance for patients with bladder cancer before cystoscopy examination.