本文選題：膀胱癌 + 熒光原位雜交��； 參考：《揚州大學(xué)》2014年碩士論文

【摘要】：目的： 探討膀胱癌術(shù)后表柔比星膀胱內(nèi)灌注治療過程中的熒光原位雜交(FISH)檢測結(jié)果與患者腫瘤復(fù)發(fā)及進展之間的關(guān)系。 方法： 將手術(shù)病理證實為非肌層浸潤膀胱移行細胞癌,術(shù)后接受表柔比星膀胱內(nèi)灌注治療的患者納入臨床研究。以灌注前、1月末、3月末為觀察點,分別在各觀察點收集患者的晨尿標(biāo)本行FISH檢測并記錄其結(jié)果。分析FISH結(jié)果和腫瘤復(fù)發(fā)及進展之間的關(guān)系。 結(jié)果： 1.共有43位患者納入研究,其中男41例(95.3%),女2例(4.7%),平均年齡63.7歲。在21.3月的中位隨訪時間中,有15例(34.9%)患者發(fā)生腫瘤復(fù)發(fā),6例(14.0%)患者進展為肌層浸潤性腫瘤。 2.手術(shù)后行表柔比星膀胱內(nèi)灌注過程中,每個觀察點的FISH結(jié)果陽性的患者較陰性者都具有更高的腫瘤復(fù)發(fā)率和腫瘤進展率。從復(fù)發(fā)情況看,灌注前和1月末的FISH結(jié)果為陽性的患者與結(jié)果為陰性者發(fā)生腫瘤復(fù)發(fā)的風(fēng)險分別為48.3%VS.7.1%(P=0.021)和56.3%VS.22.2%(P=0.024),結(jié)果有統(tǒng)計學(xué)差異；3月末的FISH結(jié)果為陽性的患者與結(jié)果為陰性者發(fā)生腫瘤復(fù)發(fā)的風(fēng)險為42.1%VS.29.2%(P=0.377),結(jié)果無統(tǒng)計學(xué)差異(表2)；從進展情況看,1月末的FISH結(jié)果為陽性的患者與結(jié)果為陰性者發(fā)生腫瘤進展的風(fēng)險為31.3%VS.3.7%(P=0.039),結(jié)果有統(tǒng)計學(xué)差異；灌注前和3月末的FISH結(jié)果陽性的患者與結(jié)果為陰性者發(fā)生腫瘤進展的風(fēng)險分別為20.7%VS.0%(P=0.172)和26.3%VS.4.2%(P=0.101),結(jié)果無統(tǒng)計學(xué)差異(表3)。 3.所有患者按預(yù)設(shè)觀察點依次完成3次FISH檢測,分析每位患者的FISH檢測陽性結(jié)果的次數(shù)與其發(fā)生腫瘤復(fù)發(fā)及進展的關(guān)系。獲得1次、2次和3次陽性FISH結(jié)果的患者,其腫瘤復(fù)發(fā)率分別為36.4%(4/11)、46.2%(6/13)和55.6%(5/9),P0.05,無統(tǒng)計學(xué)差異；其腫瘤進展率分別為0%(0/11)、15.4%(2/13)和44.4%(4/9),P0.05,有統(tǒng)計學(xué)差異。 4.觀察分析灌注治療1月后的FISH檢測結(jié)果,1月末和3月末的FISH結(jié)果均陽性的患者較均陰性的患者,其腫瘤復(fù)發(fā)率分別為55.6%和17.6%,P=0.078,無統(tǒng)計學(xué)差異；其腫瘤進展率分別為44.4%和0%,P=0.008,有統(tǒng)計學(xué)差異。 結(jié)論： 1.在接受表柔比星持續(xù)膀胱內(nèi)灌注的過程中,在灌注治療后1月末時行FISH檢測,其檢測結(jié)果對預(yù)測腫瘤復(fù)發(fā)及進展具有較可靠的價值。FISH檢測結(jié)果的陽性提示患者對治療不敏感,并且面臨較高的腫瘤復(fù)發(fā)及進展風(fēng)險�？赡転檫@類患者選擇替代治療或者更為積極的治療方案提供依據(jù)。 2.多次(3次或2次)FISH檢測結(jié)果為陽性的患者較單次為陽性者發(fā)生腫瘤進展的風(fēng)險大,但其發(fā)生腫瘤復(fù)發(fā)的風(fēng)險無顯著差異。 3.在表柔比星灌注治療1月后,觀察點1月末和3月末的FISH結(jié)果均陽性者較均陰性者有更大的發(fā)生腫瘤進展的風(fēng)險,但其發(fā)生腫瘤復(fù)發(fā)的風(fēng)險無顯著差異。
[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.
【學(xué)位授予單位】：揚州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.14

【參考文獻】

相關(guān)期刊論文 前4條

1 楊立新;張海峰;白淑芬;;p53、Ki-67基因表達與膀胱癌相關(guān)性的回顧性研究[J];現(xiàn)代醫(yī)學(xué);2010年01期

2 王偉高,程一寧;表阿霉素膀胱灌注預(yù)防淺表性膀胱癌術(shù)后復(fù)發(fā)的療效觀察[J];中華泌尿外科雜志;2002年04期

3 肖澤均,張建軍,鄭閃,李長嶺,何祖根,程書鈞,高燕寧;膀胱移行細胞癌3號染色體短臂上抑癌基因雜合性缺失的研究[J];中華醫(yī)學(xué)雜志;2002年20期

4 吳忠標(biāo),林國兵,陳柏君,吳忠明,戎瑞明;不同劑量表柔比星膀胱灌注預(yù)防淺表性膀胱癌復(fù)發(fā)的療效與安全性[J];中華腫瘤雜志;2005年08期

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