荧光原位杂交技术预测膀胱癌表柔比星膀胱内灌注治疗的反应

发布时间：2018-07-10 02:21

本文选题：膀胱癌 + 荧光原位杂交　；参考：《扬州大学》2014年硕士论文

【摘要】：目的：探讨膀胱癌术后表柔比星膀胱内灌注治疗过程中的荧光原位杂交(FISH)检测结果与患者肿瘤复发及进展之间的关系。方法：将手术病理证实为非肌层浸润膀胱移行细胞癌,术后接受表柔比星膀胱内灌注治疗的患者纳入临床研究。以灌注前、1月末、3月末为观察点,分别在各观察点收集患者的晨尿标本行FISH检测并记录其结果。分析FISH结果和肿瘤复发及进展之间的关系。结果： 1.共有43位患者纳入研究,其中男41例(95.3%),女2例(4.7%),平均年龄63.7岁。在21.3月的中位随访时间中,有15例(34.9%)患者发生肿瘤复发,6例(14.0%)患者进展为肌层浸润性肿瘤。 2.手术后行表柔比星膀胱内灌注过程中,每个观察点的FISH结果阳性的患者较阴性者都具有更高的肿瘤复发率和肿瘤进展率。从复发情况看,灌注前和1月末的FISH结果为阳性的患者与结果为阴性者发生肿瘤复发的风险分别为48.3%VS.7.1%(P=0.021)和56.3%VS.22.2%(P=0.024),结果有统计学差异；3月末的FISH结果为阳性的患者与结果为阴性者发生肿瘤复发的风险为42.1%VS.29.2%(P=0.377),结果无统计学差异(表2)；从进展情况看,1月末的FISH结果为阳性的患者与结果为阴性者发生肿瘤进展的风险为31.3%VS.3.7%(P=0.039),结果有统计学差异；灌注前和3月末的FISH结果阳性的患者与结果为阴性者发生肿瘤进展的风险分别为20.7%VS.0%(P=0.172)和26.3%VS.4.2%(P=0.101),结果无统计学差异(表3)。 3.所有患者按预设观察点依次完成3次FISH检测,分析每位患者的FISH检测阳性结果的次数与其发生肿瘤复发及进展的关系。获得1次、2次和3次阳性FISH结果的患者,其肿瘤复发率分别为36.4%(4/11)、46.2%(6/13)和55.6%(5/9),P0.05,无统计学差异；其肿瘤进展率分别为0%(0/11)、15.4%(2/13)和44.4%(4/9),P0.05,有统计学差异。 4.观察分析灌注治疗1月后的FISH检测结果,1月末和3月末的FISH结果均阳性的患者较均阴性的患者,其肿瘤复发率分别为55.6%和17.6%,P=0.078,无统计学差异；其肿瘤进展率分别为44.4%和0%,P=0.008,有统计学差异。结论： 1.在接受表柔比星持续膀胱内灌注的过程中,在灌注治疗后1月末时行FISH检测,其检测结果对预测肿瘤复发及进展具有较可靠的价值。FISH检测结果的阳性提示患者对治疗不敏感,并且面临较高的肿瘤复发及进展风险。可能为这类患者选择替代治疗或者更为积极的治疗方案提供依据。 2.多次(3次或2次)FISH检测结果为阳性的患者较单次为阳性者发生肿瘤进展的风险大,但其发生肿瘤复发的风险无显著差异。 3.在表柔比星灌注治疗1月后,观察点1月末和3月末的FISH结果均阳性者较均阴性者有更大的发生肿瘤进展的风险,但其发生肿瘤复发的风险无显著差异。
[Abstract]:Objective: to investigate the relationship between fluorescence in situ hybridization (fish) and tumor recurrence and progression during intravesical instillation of epirubicin in bladder cancer patients. Methods: patients with transitional cell carcinoma of bladder proved by surgery and pathology who received intravesical instillation of epirubicin were included in the clinical study. At the end of January and the end of March before perfusion, the morning urine samples of the patients were collected and the results were recorded by fish. The relationship between fish results and tumor recurrence and progression was analyzed. Results: 1. A total of 43 patients were enrolled in the study, including 41 males (95.3%) and 2 females (4.7%), with an average age of 63.7 years. In the median follow-up period of 21.3 months, 15 cases (34.9%) developed tumor recurrence and 6 cases (14.0%) developed myometrial invasion tumor. 2. During intravesical instillation of epirubicin after operation, the patients with positive fish results at each observation point had higher tumor recurrence rate and tumor progression rate than those with negative results. From the point of view of recurrence, the risk of tumor recurrence was 48.3 vs 7.1% (P0. 021) and 56.3 vs 22. 2% (P0. 024) in the patients with positive fish results and those with negative results, respectively. There was significant difference between the two groups. At the end of 3 months, the risk of tumor recurrence was 42.1% (P < 0.377) in fish positive patients and 42.1% in negative ones (P < 0.05). There was no significant difference in the results (Table 2). At the end of January, the risk of tumor progression was 31.3VS.3.7% (P0.039) in the patients with positive fish results and those with negative results (P0.039). The risk of tumor progression was 20.7VS.0% (P0. 172) and 26.3VS.4.2% (P0. 101) in the patients with positive fish results before and at the end of March, respectively. There was no statistical difference between the two groups (Table 3) 3. 3. The risk of tumor progression in the patients with positive fish results was 20.7VS.0% (P0. 172) and 26. 3VS.4.2% (P0. 101) respectively. According to the preset observation point, all the patients completed three fish tests in turn. The relationship between the number of fish positive results and the recurrence and progression of tumor was analyzed. The tumor recurrence rates were 36.4% (4 / 11), 46.2% (6 / 13) and 55.6% (5 / 9), respectively, with no statistical difference, and the tumor progression rates were 0% (0 / 11) 15.4% (2 / 13) and 44.4% (44.9%) P0.05respectively. The results of fish after 1 month of perfusion therapy were observed and analyzed. The recurrence rate of fish in the patients with positive fish results at the end of January and the end of March was 55.6% and 17.6P 0.078, respectively. There was no statistical difference between the two groups. The tumor progression rate was 44. 4% and 0. 008, respectively. Conclusion: 1. During the course of continuous intravesical instillation of epirubicin, fish was detected at the end of 1 month after perfusion therapy. The results of fish were reliable in predicting tumor recurrence and progression. The positive results of fish showed that the patients were not sensitive to treatment. And face a higher risk of tumor recurrence and progression. May provide a basis for such patients to choose alternative treatment or more aggressive treatment options. 2. 2. The risk of tumor progression in patients with multiple (3 or 2) fish positive results was higher than that in single positive patients, but there was no significant difference in the risk of tumor recurrence. 3. After epirubicin infusion for one month, the risk of tumor progression was higher in those with positive fish results at the end of January and March than those with negative results, but there was no significant difference in the risk of tumor recurrence.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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