pcdh10下调与膀胱癌恶性行为及不良预后相关

pcdh10下调与膀胱癌恶性行为及不良预后相关
pcdh10下调与膀胱癌恶性行为及不良预后相关

Research Report

Downregulation of

protocadherin-10expression correlates with malignant behaviour and poor

prognosis in human bladder cancer

Jian-Guo Ma,1,2Zheng-Kai He,1Jian-Hua Ma,3Wen-Ping Li 2and Guang Sun 1

Abstract

Objectives:This study retrospectively evaluated the prognostic significance of downregulated protocadherin-10(PCDH10)gene expression in bladder cancer.

Methods:T o evaluate the prognostic significance of downregulated PCDH10protein levels,immunohistochemistry was used to assess the level of PCDH10protein in surgically-resected formalin-fixed,paraffin wax-embedded transitional cell carcinoma specimens.Relationships between PCDH10protein levels,clinicopathological characteristics and overall survival were also evaluated.

Results:A total of 105bladder transitional cell carcinoma specimens and 33normal bladder epithelial samples were investigated using immunohistochemical staining.PCDH10protein levels were downregulated in 63.8%(67/105)of bladder cancer specimens compared with control samples.Downregulated levels of PCDH10were significantly associated with advanced stage,higher grade,larger tumour size,nonpapillary shape,tumour recurrence and decreased overall survival rates.Multivariate analysis indicated that downregulated PCDH10levels were independ-ently associated with decreased overall survival and had a relative risk of death of 4.571.

Conclusions:Downregulated PCDH10levels correlated with malignant behaviour and poor overall survival in patients with bladder cancer.Downregulated PCDH10levels might be useful as a prognostic biomarker for bladder cancer.

Journal of International Medical Research

41(1)38–47

!The Author(s)2013Reprints and permissions:

https://www.360docs.net/doc/7710998940.html,/journalsPermissions.nav

DOI:10.1177/0300060513476989

https://www.360docs.net/doc/7710998940.html,

1

Department of Urology,Second Hospital of Tianjin Medical University,Tianjin,China 2

Department of Urology,Third Hospital of Hebei Medical University,Shijiazhuang,Hebei Province,China 3

Department of Gerontology,Chengde Central Hospital,Chengde,Hebei Province,China

Corresponding author:

Dr Jian-Hua Ma,Department of Gerontology,Chengde Central Hospital,11North Xidajie Street,Chengde 067000,Hebei Province,China.Email:mjh2012cd@https://www.360docs.net/doc/7710998940.html,

Keywords

Bladder cancer,clinicopathological characteristics,immunohistochemistry,protocadherin-10 (PCDH10)

Date received:24September2012;accepted:21October2012

Introduction

Bladder cancer is a common international public health problem,with an estimated global incidence of>356,000new cases per year and a prevalence rate of2.7million cases.1In the USA,bladder cancer is the second most common genitourinary malig-nancy,with an estimated73,510new cases and14,880deaths in2012.2However,the incidence of bladder cancer is increasing in developing areas of the world,attributed to global changes in exposure to risk factors for bladder cancer,and growth and ageing of the population.1Risk factors correlated with bladder cancer include cigarette smoking, chronic bladder in?ammation,exposure to carcinogenic chemicals,genetic predispos-ition and age.3Of newly diagnosed bladder cancer cases,over90%are transitional cell carcinomas;in terms of invasiveness, $70–80%are nonmuscle-invasive tumours (tumour stages T a–T1)and the remainder are muscle-invasive tumours(tumour stages T2–T4).3The outcome of bladder cancer patients is variable because tumours that are morphologically similar can behave di?er-ently.3Therefore,speci?c biomarkers that could serve as prognostic indicators are needed to identify patients who need more aggressive systemic therapy.

Protocadherin-10(PCDH10)is a member of the protocadherin subfamily,which in turn belongs to the cadherin superfamily.4 The cadherin superfamily of transmembrane glycoproteins includes the protocadherins, atypical cadherins,desmosomal cadherins, cadherin-related neuronal receptors and classic cadherins.4Cadherins play important roles in calcium-dependent homophilic cell–cell adhesion,and are involved in the estab-lishment of cell polarity,cell-sorting,cell di?erentiation,proliferation and migra-tion.4Studies have demonstrated that PCDH10is a putative tumour-suppressor gene;the human PCDH10gene is located at 4q28.3,and promoter methylation and downregulation of PCDH10gene expres-sion has been demonstrated in many human cancers including hepatocellular carcinoma, multiple myeloma,gastric cancer,medullo-blastoma,prostate cancer,colorectal cancer, pancreatic cancer and cervical cancer.4–10 In addition,ectopic expression of the PCDH10gene suppressed tumour cell growth,migration,invasion and colony formation.11However,the expression of the PCDH10gene in bladder cancer and its clinical signi?cance remains unclear.

The present study investigated levels of PCDH10protein in bladder cancer tissues and control samples using immunohisto-chemical staining,in order to determine if there is any relationship between PCDH10 protein levels and clinicopathological fea-tures and the prognosis of patients with bladder cancer.

Patients and methods Participants and Sample Collection

This retrospective study collected tumour samples obtained during surgery at the Department of Urology,Second Hospital of Tianjin Medical University,Tianjin, China,from patients with bladder transi-tional cell carcinoma.The patients had been diagnosed pathologically between

39Ma et al.

January2003and June2006.Tumour diag-nosis,staging,treatment and follow-up were completed according to international stand-ards.12The inclusion criteria for patients with bladder cancer were:histopathological diagnosis of bladder transitional cell carcin-oma;no history of other tumours;availabil-ity of follow-up data.

Normal bladder epithelial tissues were collected as controls from inpatients with bladder calculi,treated at the same hospital, during the same time period;these tissue samples were examined pathologically to exclude the possibility of incidental tumours.Inclusion criteria for control sub-jects were no history of any malignant tumours and no prior treatment with antic-ancer therapy.All of the tissue samples were ?xed with10%formalin and embedded in para?n wax.

All patients with bladder cancer were followed-up after primary treatment at the Department of Urology,Second Hospital of Tianjin Medical University,at intervals increasing from3months to12months. Follow-up continued until the death of the patient or to60months if the patient remained alive.Follow-up data were rec-orded using both hospital?les and informa-tion from the urologist or family physician responsible for the patient.Overall survival data for the patients with bladder cancer were collected during follow-up;overall survival was de?ned as the time from the date of diagnosis to the date of death from any cause,or the date of last contact if the patient was still alive,as previously described.13,14For data analysis,patients with bladder cancer were divided into two groups according to the level of PCDH10 protein immunoreactivity determined by 3,30-diaminobenzidine(DAB)immunohis-tochemistry:the normal PCDH10protein level group and the downregulated PCDH10 protein level group.

Written informed consent was obtained from each study participant.This study was conducted in accordance with the Declaration of Helsiniki(2008)15and approved by the Ethics Committee of the Second Hospital of Tianjin Medical University. Immunohistochemical Analysis

for PCDH10

Immunohistochemical staining was used to detect the level of PCDH10protein in tissue samples,as reported previously.16,17Brie?y, 4-m m formalin-?xed and para?n wax-embedded sections were depara?nized in xylene,and xylene was removed through a graded series of alcohol.Endogenous per-oxidase activity was blocked with3% hydrogen peroxide for10min.Antigen retrieval was performed by boiling the sec-tions in10mM sodium citrate bu?er(pH 6.0)for15min.Sections were then incubated with mouse antihuman PCDH10monoclo-nal antibody(1:100dilution;Santa Cruz Biotechnology,Santa Cruz,CA,USA)at 4 C overnight.After washing three times with10mM phosphate-bu?ered saline (PBS;pH7.4),sections were incubated with horseradish peroxidase goat antimouse secondary antibody(1:100dilution;Santa Cruz Biotechnology)at37 C for20min and washed three times with10mM PBS(pH 7.4).Finally,the immunolabelling was visualized with0.05%DAB(Sigma-Aldrich,St Louis,MO,USA)diluted with 0.05M Tris-bu?ered saline(pH7.6),and all sections were counterstained with haema-toxylin and mounted for light microscopy. Scoring of PCDH10Immunoreactivity Assessment of the immunohistochemical staining results was undertaken by two pathologists who were blinded to the patients’clinicopathological data.Normal bladder epithelial tissues were used as inter-nal positive controls.The level of PCDH10 protein immunoreactivity in cancer cells was

Journal of International Medical Research41(1)40

compared with that of normal epithelial cells.In accordance with previously pub-lished criteria,16,18cancer cells that were stained in similar ways to normal epithelial cells were de?ned as having normal PCDH10protein levels.The level of PCDH10protein immunoreactivity was graded according to the proportion of posi-tive cells.The percentage of positive cells was calculated by dividing the total number of positive cells with the total number of all cells,in at least ten randomly chosen non-overlapping high-power(?400)?elds for each case,using a light microscope (Olympus Optical,Tokyo,Japan).When >90%of the cancer cells were positively stained for the PCDH10protein,the tumours were considered to be uniformly positive and regarded as having normal PCDH10protein levels.When10–90%of the cancer cells were positively stained for the PCDH10protein,the tumours were considered to be heterogeneous;when <10%of the cancer cells were positively stained for the PCDH10protein,the tumours were considered to be negative. Heterogeneous and negative staining were counted together as a downregulated PCDH10protein level.16,18

Statistical Analyses

All statistical analyses were performed using the SAS?statistical software package,ver-sion8.0(SAS Institute,Cary,NC,USA)for Windows?.The 2-test was used to assess the associations between the level of PCDH10protein immunoreactivity and clinicopathological features.Kaplan–Meier survival analysis and log-rank test were used to assess the di?erence of overall survival between patients with normal and down-regulated levels of PCDH10protein immu-noreactivity.Multivariate Cox proportional hazard model analysis was used to estimate the independent prognostic e?ect of the level of PCDH10protein immunoreactivity after controlling for classic risk factors of stage, grade,tumour size and tumour recurrence.

A P-value<0.05was considered to be statistically signi?cant.

Results

This study included29female and76male patients with bladder cancer with a median age of68years(range28–89years).The control group comprised nine females and 24males with a median age of67years (range24–87years).Control subjects were matched to the bladder cancer cases by age and sex.Clinicopathological features of the patients with bladder cancer are summarized in Table1.

Immunohistochemical analysis of the level of PCDH10protein immunoreactivity in tissue specimens from105patients with bladder cancer and33control subjects found that all of the normal bladder epithe-lia showed equally strong PCDH10protein immunoreactivity(>90%of the cells were positively stained)as shown in Figure1A, which served as an internal positive control. Downregulated PCDH10protein immunor-eactivity was detected in67out of105 (63.8%)tumour specimens,including 46out of105(43.8%)heterogeneously stained tumours(Figure1B)and21out of 105(20.0%)negatively stained tumours (Figure1C),which were all considered as having downregulated PCDH10protein levels.Normal PCDH10protein levels were detected in38of105(36.2%)patients with bladder cancer.

Downregulated levels of PCDH10 protein immunoreactivity were signi?-cantly associated with advanced dis-ease stage(P?0.0043),larger tumour size(P?0.0316),poor di?erentiation (P?0.0103),tumour recurrence(P?0.0213)and a nonpapillary tumour shape (P?0.0433)(Table1).However,there was no association between downregulated

41Ma et al.

levels of PCDH10protein immunoreactivity and age,sex or tumour number.

The mean?SD follow-up duration among the105patients with bladder cancer was51.9?15.5months(range5–60 months).Kaplan–Meier survival analysis found that patients with downregulated levels of PCDH10protein immunoreactivity had a signi?cantly reduced survival time, compared with patients who had normal levels of PCDH10protein immunoreactivity (P?0.0055)(Figure2).In the multivariate Cox proportional hazard model analysis (which controlled for the classic risk factors of stage,grade,tumour size and tumour recurrence),downregulated PCDH10pro-tein immunoreactivity was independently associated with poor overall survival and had a relative risk of death of4.571(95% con?dence interval 2.013,10.371; P?0.0067)(Table2).

Discussion

Bladder cancer is a common malignancy, reported worldwide,that is associated with high levels of morbidity and mortality.1 Unfortunately,the mortality rate for

T able1.Relationship between protocadherin-10(PCDH10)immunoreactivity and clinicopathological characteristics in patients with bladder cancer(n?105).

Characteristic n Level of PCDH10protein immunoreactivity

in bladder tumour samples,n?105

Statistical

significance c Downregulated level

of PCDH10

immunoreactivity a

Normal level

of PCDH10

immunoreactivity b

T otal10567(63.8)38(36.2)

Age65years3622(61.1)14(38.9)NS

>65years6945(65.2)24(34.8)

Sex Male7652(68.4)24(31.6)NS

Female2915(51.7)14(48.3)

T umour number Single4528(62.2)17(37.8)NS

Multiple6039(65.0)21(35.0)

T umour size3cm6637(56.1)29(43.9)0.0316

>3cm3930(76.9)9(23.1)

T umour shape Papillary7342(57.5)31(42.5)0.0433

Nonpapillary3225(78.1)7(21.9)

T umour occurrence Primary7140(56.3)31(43.7)0.0213

Recurrent3427(79.4)7(20.6)

Grade G14120(48.8)21(51.2)0.0103

G2–G36447(73.4)17(26.6)

Stage T a–T16736(53.7)31(46.3)0.0043

T2–T43831(81.6)7(18.4)

Data presented as n(%)of patients.

a Downregulated PCDH10protein immunoreactivity levels were defined as patients having90%positively-stained cells. Downregulated PCDH10protein immunoreactivity levels were further categorized as‘negative staining’when<10%of the cells were stained or as‘heterogeneous staining’when10–90%of the cells were stained.

b Normal levels of PCDH10protein immunoreactivity were defined as patients having>90%positively-stained cells.

c P<0.05compare

d with th

e downregulated PCDH10protein immunoreactivity group; 2-test.

T a–T1,nonmuscle-invasive tumours;T2–T4,muscle-invasive tumours;NS,no statistically significant between-group differences(P!0.05).

Journal of International Medical Research41(1)42

Figure 2.Kaplan–Meier survival analysis for patients with bladder cancer (n ?105),according to the level of protocadherin-10(PCDH10)protein immunoreactivity in tumour samples.Patients with normal levels of PCDH10protein immunoreactivity (>90%of the cells were positively stained;n ?38)versus downregulated levels of PCDH10protein immunoreactivity ( 90%of the cells were positively stained;n ?67).P ?0.0055(log-rank

test).

Figure 1.Representative light photomicrographs showing immunohistochemical staining for protocad-herin-10(PCDH10)protein in tumour samples from patients with bladder cancer and normal bladder epithelium from healthy control subjects.(A)PCDH10immunoreactivity in normal bladder epithelium;(B)heterogeneous PCDH10immunoreactivity in bladder cancer tissue;(C)negative PCDH10immunor-eactivity in bladder cancer tissue.Scale bars are indicated by the space between the square brackets,which represents 100m m.

43Ma et al.

patients with bladder cancer increases with the extent of tumour invasion,despite the advances that have been made in tumour detection,treatment and surveil-lance strategies.For example,the approxi-mate5-year overall survival rates are$90% for nonmuscle-invasive disease,$60%for T2disease and$35%for T3disease, decreasing to$25%for T4disease.19–21 Therefore,it is important to identify those patients who might bene?t most from adju-vant therapy after surgery,so as to obtain better rates of prognosis.Currently,tumour grade and stage have been used as the most important prognostic characteristics,but both measures fail to predict patient prog-nosis accurately because tumours with simi-lar morphology can behave di?erently.3 Therefore,more reliable and objective bio-markers of prognosis are required.

The molecular aetiology of bladder cancer remains largely unknown,but many oncogenes and tumour suppressor genes that may play a role in the pathogenesis of bladder cancer have been identi?ed,and could be useful when determining patient prognosis.3,17–21The PCDH10gene is a novel tumour suppressor gene;in many human cancer types,the PCDH10gene has been shown to be downregulated by pro-moter methylation,and this downregulation correlates with a poor prognosis.4–11,22 In the present study,the level of PCDH10 protein immunoreactivity in bladder cancer specimens was downregulated compared with normal bladder epithelial tissues,sug-gesting that downregulation of the PCDH10 protein level might play an important role in the pathogenesis and progression of bladder cancer.

To elucidate the clinical signi?cance of the levels of PCDH10protein in bladder cancer,the present study evaluated the associations between PCDH10protein immunoreactivity and clinicopathological characteristics.Invasion is the most import-ant biological characteristic of human tumours,and is the major cause of treatment failure and death in patients with bladder cancer.23In the current study,downregu-lated levels of PCDH10immunoreactivity were detected in36out of67(53.7%) nonmuscle-invasive tumours(T a–T1),com-pared with31out of38(81.6%)muscle-invasive tumours(T2–T4).This?nding indi-cated that decreased levels of PCDH10

T able2.Multivariate Cox proportional hazard model analysis of potential prognostic indicators for overall survival(OS)in patients with bladder cancer(n?105).

Characteristic HR for OS(95%CI)Statistical significance PCDH10immunoreactivity(downregulated versus

normal levels)

4.571(2.013,10.371)P?0.0067

Stage(T2–T4versus T a–T1) 3.965(1.873,9.689)P?0.0142

Grade(G3versus G1–G2) 3.638(1.451,8.352)P?0.0379

T umour recurrence(yes versus no) 3.036(1.173,9,058)NS

T umour number(multiple versus single) 2.766(1.053,7.673)NS

T umour size(>3cm versus3cm) 2.578(0.873,6.968)NS

T umour shape(nonpapillary versus papillary) 1.873(0.936,4.563)NS

Sex(male versus female) 1.063(0.517,3.423)NS

Age(>65years versus65years) 1.133(0.671,3.597)NS

Hazard ratio(HR)>1.0represents a positive correlation with risk;HR<1.0represents an inverse correlation with risk. CI,confidence interval;PCDH10,protocadherin-10;T a–T1,nonmuscle-invasive tumours;T2–T4,muscle-invasive tumours; NS,no statistically significant differences(P!0.05).

Journal of International Medical Research41(1)44

immunoreactivity were closely associated with bladder-cancer invasiveness.This result is in agreement with other studies, which showed that decreased levels of PCDH10protein were also found in gastric cancer cells and tissues,and were associated with tumour invasiveness,4and that restor-ation of normal levels of PCDH10protein in gastric cancer cells suppressed cell migration and invasion in vitro;4similar?ndings were demonstrated in medulloblastoma and pros-tate cancer studies.6,7Taken together,these ?ndings suggest that decreased PCDH10 protein levels may facilitate tumour invasion.

Di?erentiation is an important factor that contributes to tumour progression and determines patient outcomes.23In the cur-rent study,downregulated levels of PCDH10immunoreactivity were detected in20of41(48.8%)well-di?erentiated tumours(G1),compared with47of64 (73.4%)moderate or poorly di?erentiated tumours(G2–G3).This?nding indicated that downregulated PCDH10protein levels correlated with poor di?erentiation of blad-der cancer.In addition,downregulated PCDH10protein levels occurred in37out of66(56.1%)patients with tumours3cm in diameter and in30out of39(76.9%) patients with tumours>3cm,which sug-gested that downregulated levels of PCDH10protein might promote bladder cancer growth.This?nding is similar to studies undertaken in gastric cancer,pros-tate cancer and medulloblastoma.4,6,7 Tumour recurrence is an important char-acteristic of bladder cancer that in?uences patient outcomes.24–26In the present study, among the105patients with bladder cancer, the proportion of patients with downregu-lated levels of PCDH10protein immunor-eactivity in the recurrent group(27/34, 79.4%)was signi?cantly higher than in the primary group(40/71,56.3%)(P?0.0213), suggesting that downregulated PCDH10 protein might contribute to the recurrence of bladder cancer.In addition,a down-regulated level of PCDH10protein immu-noreactivity was signi?cantly correlated with a nonpapillary tumour shape (P?0.0433).

Taken together,current data suggest that downregulated PCDH10protein levels,as identi?ed by immunohistochemistry of tumour samples,are closely associated with the malignant behaviour of bladder cancer and might be used as a prognostic bio-marker for bladder cancer patients.In order to con?rm this hypothesis,overall survival was examined in this current study and patients with downregulated levels of PCDH10protein immunoreactivity had a worse prognosis than those with normal PCDH10protein levels.Moreover,multi-variate Cox regression analysis indicated that a downregulated PCDH10protein level was an independent predictor of poor overall survival after controlling for classic risk factors.This?nding supports that of a previous report in gastric cancer.22These current?ndings suggest that a downregu-lated PCDH10protein level might be a potential prognostic biomarker of overall survival in human bladder cancer.

In conclusion,the present study demon-strated that downregulated PCDH10pro-tein immunoreactivity was signi?cantly correlated with the malignant behaviour of bladder cancer,and may be used as a potential prognostic biomarker of overall survival,for patients with bladder cancer. As the current study was limited by a small sample size,additional studies are needed to con?rm these preliminary?ndings.In our opinion,if these current?ndings can be con?rmed by larger independent studies,we would recommend using downregulated PCDH10protein levels in tumour samples as a routine prognostic biomarker.This strategy would enable patients with bladder cancer to be o?ered the most appropriate therapeutic interventions following surgery, including radiotherapy,chemotherapy or

45Ma et al.

biological therapy,with the goal of achiev-ing the best attainable prognosis for each patient.

Declaration of Conflicting Interest

The authors declare that there are no con?icts of interest.

Funding

This research received no speci?c grant from any funding agency in the public,commercial,or not-for-pro?t sectors.

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47Ma et al.

膀胱癌基本知识(科普版)

膀胱癌基本知识(科普版) 膀胱肿瘤是泌尿外科的常见病,膀胱肿瘤绝大多数为上皮性肿瘤。膀胱癌可发生于任何年龄,但多见于中老年人;青少年和20岁以内的成年人患膀胱癌多为分化较好的浅表性肿瘤,预后较好。 一、膀胱癌的病因 1.吸烟 ●?吸烟系目前最为肯定的膀胱癌致病危险因素 ●?约30-50% 的膀胱癌由吸烟引起 ●?吸烟可使膀胱癌危险率增加2-4倍 ●?发病风险与吸烟的数量、时间以及吸烟时吸入的深度有关。戒烟后发病风险可下降。2.长期接触工业化学产品 ●?约20%的膀胱癌由职业因素引起 ●?苯胺、联苯胺、氨基联苯、双氨基联苯、二氯联苯胺等为致癌物质。 ●?增加患膀胱癌危险性的职业有:染料工业、橡胶、制革、油漆、印刷、钻探、煤矿、 干洗、理发、牙医等。 3.咖啡 某些流行病学研究发现饮用咖啡可增加膀胱癌的发病率,但若同时考虑到吸烟、人工甜味剂等因素,并无明确证据表明咖啡可促进膀胱癌的发生。 4.镇痛药物 非那西丁是苯胺的衍生物,长期大量应用非那西丁类镇痛药可增加尿路上皮癌的发生率,发生膀胱癌的潜伏期比肾盂癌长,可长达25年。其他类型的镇痛药与膀胱癌的发生无明确关系。 5.人工甜味剂 在啮齿类动物实验中发现,大剂量的人工甜味剂,包括邻磺酸苯甲酰亚胺(糖精)和环己烷氨基磺酸盐,为膀胱致癌物质。但流行病学调查发现,食用人工甜味剂并不明显增加膀胱癌的发生率,目前认为,不吸烟的女性和大量吸烟的男性食用人工甜味剂可使膀胱癌的发生率有所增加。 6.慢性膀胱炎和其他感染

留置导尿管或结石引起的慢性膀胱炎可增加膀胱鳞癌的发病率,因截瘫而长期留置导尿管的人群中膀胱癌的发生率为2-10%,其中80%为鳞状细胞癌。血吸虫病流行地区膀胱鳞状细胞癌的发病率很高,移行细胞癌的发生率也升高。膀胱内人乳头状瘤病毒感染与膀胱鳞状细胞癌的发生也有密切关系。 7.盆腔放疗 子宫颈癌的病人接受盆腔放射治疗,发生膀胱移行细胞癌的风险增加,而且在诊断时多为高分期且有局部浸润。 8.环磷酰胺 接受环磷酰胺治疗的病人膀胱癌的发生率可增加9倍,诊断时多发生膀胱肌肉浸润。目前认为环磷酰胺在尿路的代谢产物:丙烯醛,与出血性膀胱炎和膀胱癌的发生有关。环磷酰胺引起的膀胱癌潜伏期为6-13年。 二、膀胱癌的临床表现 1.血尿 ●?血尿特别是间歇性无痛肉眼血尿为膀胱肿瘤最常见的病状 ●?对于中老年人出现原因不明的血尿就应当膀胱镜检以除外膀胱癌。 ●?血尿程度依出血量多少,表现为洗肉水样、伴有不规则或片状血块,甚至大量血块 充满膀胱。血尿出现的时间和程度与肿瘤细胞分化、分期、大小、数目、形态并不一致,出血严重或反复出血者可发生失血性贫血。 2.膀胱刺激症状 ●?膀胱刺激症状,即尿频、尿急、尿痛,为膀胱癌的第二个常见病状 ●?凡有膀胱刺激症状或排出过“腐肉”的膀胱癌,多属晚期或浸润性,预后不良。3.其他表现 ●?膀胱颈部或累及前列腺的癌肿、颈部附近带蒂癌肿及大块坏死脱落的癌组织,均可 阻塞颈口而出现尿潴留。 ●?癌肿累及输尿管口,则可出现肾区胀痛、肾输尿管积水、感染、肾功能损害。 ●?膀胱肿瘤晚期病人可出现下腹部肿块,肾功能不全,消瘦、严重贫血等恶液质表现。 ●?发生转移则可出现转移部位的相应症状,常发生的转移部位为骨、肝、肺。 [膀胱癌诊断分析] ●?膀胱癌的主要症状为血尿,凡40岁以上出现无痛性肉眼血尿者都应想到膀胱癌的可 能。镜下血尿或无血尿有尿路刺激症状者应进行全面而深入地检查。

无不良记录承诺书

无不良记录承诺书 一、本公司在湖北省地区无不良行为记录。 二、如承诺虚假,本公司愿意承担一切法律后果。 承诺单位(公章): 法定代表人或委托代理人(签名):日期: 无不良行为记录承诺书 本人 ** 系 ** 的法定代表人,现承诺我方拟派往********第***标段的项目经理 ***********。且公司近3年内无重大质量、安全事故,无重大经济纠纷,无商业贿赂、行政处罚等不良行为记录。 如承诺虚假,本公司愿意承担一切法律后果。 特此承诺! 承诺单位:*********************************(盖单位章)法定代表人或其委托代理人:(盖章或签字)年月日 不良行为记录和违法、违规行为承诺书 我公司近三年在浙江省范围内政府采购领域中,在项目招标、投标和合同履约期间无不良行为和违法、违规记录。若我公司虚假承诺,将自行承担由此带来的一切后果承诺人(盖章):

法定代表人或被授权代表(签字或盖章): 日期: 无不良行为记录承诺书 在此郑重承诺: 1.我方保证没有处于被责令停业,经营资格被取消,财产被接管、冻结,破产状态; 2.保证在最近三年内没有违法经营和严重违约及所经营的项目未发生重大工程质量、安全事故。 如果在该项目资格预审、申请创业扶持资金过程中或者在申请成功后,上级有关单位发现并查实我公司在所报的该项目资格预审文件中存在虚假或不真实的信息或者伪造数据、资料或证书等情况,不管上级单位有无合法的处罚依据,我公司将无条件的放弃该项目的经营资格和创业扶持基金申请资格。 本承诺具有相对独立性,不管是否有其他相反的说明,本承诺既是我公司申请资格预审申请文件的有效组成内容,也是我公司获得申请后所递交资料的有限组成内容,是我公司真实意思的表示,对我公司在该项目有关的任何行为中始终具有优先的法律约束力。 创业扶持基金申请人:(签字)公司法人:(签字)申请公司地址:

浅表性膀胱癌术后生活质量及其影响因素分析

浅表性膀胱癌术后生活质量及其影响因素分析 摘要目的探讨浅表性膀胱癌患者术后生活质量,并分析其影响因素。方法对97例浅表性膀胱癌患者进行问卷调查,并比较不同的社会人口学因素对其生活质量的影响。结果浅表性膀胱癌患者术后生活质量下降明显,年龄>70岁、低文化、低收入的患者生活质量较差,差异有统计学意义(P<0.05),而性别对生活质量无明显影响。结论浅表性膀胱癌患者术后生活质量降低,年龄、文化程度、收入状况是影响生活质量的重要因素。该研究为临床治疗决策、医疗资源分配和患者的健康教育提供一定的依据。 关键词浅表性膀胱癌;生活质量;影响因素 【Abstract】Objective To investigate postoperative quality of life in superficial bladder cancer patients,and to analyze the influencing factor. Methods A total of 97 superficial bladder cancer patients received survey. Influences by difference social demographic factors on quality of life were compared. Results Superficial bladder cancer patients had obviously reduced quality of life after operation. Those with age > 70 years old,low education level,and low income had poor quality of life. The difference had statistical significance (P<0.05). There was no influence by gender on quality of life in patients. Conclusion Postoperative quality of life is poor in superficial bladder cancer patients,and its main influencing factors include age,education level and income. This research provides certain reference for treatment regime,medical resource distribution,and health education for patients. 【Key words】Superficial bladder cancer;Quality of life;Influencing factor 膀胱癌是我國临床上最常见的肿瘤之一,是一种直接威胁患者生存的疾病,世界范围内膀胱癌发病率位居恶性肿瘤的第9位,并有逐年增多的趋势,严重影响了患者的生活质量[1,2]。目前,尽管有很多关于膀胱癌患者生存质量的报道,但这些报道主要集中于肌层浸润性膀胱癌,而对非肌层浸润性膀胱癌患者生存质量评价的报道较少[3,4]。为此,作者对浅表性膀胱癌患者术后生活质量进行调查随访,并分析其影响因素,以比较不同的社会人口学因素对其生活质量的影响。现将结果分析报告如下。 1 资料与方法 1. 1 一般资料选择2012年6月~2014年12月在本院住院的浅表性膀胱癌患者,纳入标准:①病理诊断为非肌层浸润性膀胱癌(Ta,T1);②无认知障碍;③能理解本次调查的内容及目的;④知情同意者。排除标准:有明显的重大疾病和生理缺陷(如严重心脑血管疾病,神经系统疾病,运动器官疾病,明显残疾者或视觉、听觉障碍等),严重影响生存质量者。 1. 2 方法手术后1个月,采用门诊问卷调查的方式,向被调查患者逐条

2017 AUA非肌层浸润性膀胱癌治疗指南

2017 AUA非肌层浸润性膀胱癌治疗指南 1.发病率: 2015年美国新发膀胱癌74,000例,其中75%为非肌层浸润性膀胱癌(NMIBC)。膀胱癌男女发病比例为3:1,发病率在男性恶性实体肿瘤中居第4位。 2.病因学: 危险因素:吸烟、职业暴露于致癌物、其他肿瘤化疗、Lynch综合征、感染、盆部外放疗。分子机制和遗传学改变:GSTM-1、NAT-2、TP53、RB1、PTEN、FGFR3、PIK3CA、RAS 等基因突变、9p杂合性缺失、p16表达缺失、CDKN2A纯合性缺失。 3.分期分级: 推荐使用2004年WHO/国际泌尿病理协会(ISUP)分级系统对NMIBC进行分级,分为增生(扁平和乳头样)、反应性不典型增生、意义不确定的不典型增生、尿路上皮异型增生、尿路上皮原位癌、尿路上皮乳头状瘤、非肌层浸润性低级别乳头状尿路上皮癌、非肌层浸润性高级别乳头状尿路上皮癌。 4.对NMIBC的风险分层系统:

低危:具备下列条件之一:单发直径≤3cm的低级别肿瘤;低度恶性乳头状尿路上皮癌 中危:具备下列条件之一:术后1年复发的低级别Ta期肿瘤;单发直径>3cm的低级别肿瘤;多灶性低级别Ta期肿瘤;≤3cm高级别Ta期肿瘤;低级别T1期肿瘤。 高危:高级别T1期肿瘤;复发性高级别Ta期肿瘤;直径>3cm或多发的高级别Ta期肿瘤;原位癌;BCG治疗失败的高级别肿瘤;变异型膀胱癌;肿瘤伴血管淋巴浸润;高级别肿瘤累及前列腺部尿道。 5.诊断: 在经尿道切除肿瘤时,应进行彻底的尿道及膀胱镜检查,明确肿瘤大小、位置、形态、数目及周围粘膜的异常。在技术可行时,应该切除全部肉眼可见肿瘤。要评估上尿路情况。对于有NMIBC病史、膀胱镜检查正常但细胞学阳性的患者,应考虑进行前列腺部尿道活检和上尿路影像,并使用增益膀胱镜技术如蓝光膀胱镜、输尿管镜或膀胱随机活检。 6.变异型膀胱癌: 变异型膀胱癌, 包括微乳头状癌、巢状癌、浆细胞样癌、神经内分泌癌、肉瘤样癌,还要关注是否存在广泛的鳞状或腺样分化,以及是否有血管淋巴浸润。变异型膀胱癌患者如果考虑保留膀胱治疗,应在初次TURBT术后4-6周进行二次电切。 由于变异型膀胱癌分期往往较高,应考虑进行膀胱根治性切除术。 7.确诊膀胱癌后的尿液标志:

护理_三基试卷8与答案

单项选择题(每题1分,共100题,共100分) 1.胃溃疡首选手术方式是( ) A.毕Ⅰ式胃大部切除术 B.毕Ⅱ式胃大部切除术 C.胃迷走神经切断术 D.胃、空肠吻合术 E.胃、回肠吻合术 2.须立即手术处理的胃大部切除术后并发症是() A.术后出血 B.十二指肠残端破裂 C.吻合口瘘 D.术后梗阻 E.倾倒综合征 3.患者男性,65岁。上腹部饱胀不适2个月,体重下降约5kg。查体:巩膜明显黄染,皮肤有抓痕,腹软,胆囊可触及。B超示内外胆管扩张,胆囊胀大,胰管稍扩张。最合适的诊断是()A.肝内胆管结石 B.病毒性肝炎 C.胆囊癌 D.胆囊炎、胆石症 E.胰头癌 4.胸部损伤后提示患者存在活动性出血的征象不包括() A.脉搏逐渐增快,血压持续下降 B.输液后血压回升,不再下降 C.胸膜腔穿刺抽血很快凝固 D.血红蛋白,红细胞计数降低 E.每小时引流量大于200ml,连续3小时 5.下肢静脉曲张患者的曲张静脉出血和慢性溃疡常出现在患侧() A.腹股沟区 B.大腿中部内侧 C.腘窝部 D.小腿中部外侧 E.足靴区和踝部 6.下肢曲张静脉剥脱术后护理措施正确的是() A.弹力绷带包扎患肢2天 B.患肢下垂 C.患肢制动 D.早期下床活动 E.1周内床上活动 7.对血栓闭塞性脉管炎患者的护理措施错误的是() A.绝对戒烟 B.患肢避免受寒 C.保持局部清洁 D.防止患肢外伤 E.患肢处放热水袋加温 8.肾损伤非手术的治疗方法不包括() A.抗休克治疗 B.应用止血药物 C.应用抗生素 D.血尿转清后鼓励患者早期下床活动 E.观察BP、P、R 及腰部肿块、血尿的变化 9.决定膀胱癌预后的主要因素是() A.肿瘤浸润深度 B.肿瘤组织类型 C.肿瘤的数目 D.肿瘤的大小 E.肿瘤的位置 10.膀胱癌术后最重要的治疗是() A.放疗 B.免疫治疗 C.介入治疗 D.膀胱内灌注治疗 E.药物治疗 11.患者男性,60岁,反复无痛性肉眼血尿1周,查尿常规示RBC(+++),B超示右肾有一直径为5厘米的占位,为进一步明确诊断,下列检查应首选() A.CT B.右逆行肾盂造影 C.KUB D.IVP E.放射性核素肾图 12.患者男性,50岁,排尿过程中突然尿流中断,疼痛剧烈,改体位后又可排尿,应考虑() A.肾结石 B.输尿管结石 C.膀胱结石 D.后尿道结石 E.前尿道结石 13.脑室引流术后患者引流管护理方法不妥的是( ) A.引流管开口高于侧脑室平面15㎝ B.妥善固定引流管 C.每日引流量不超过500ml D.定时无菌生理盐水冲洗 E.观察并记录引流液的量、性状 14.头皮帽状腱膜下血肿不能吸收时应( ) A.继续等待 B.应用止血药物 C.切开清除积血

探析浅表性膀胱癌的治疗现状与进展

探析浅表性膀胱癌的治疗现状与进展 摘要:膀胱肿瘤是我国泌尿外科最常见的肿瘤,占全部恶性肿瘤的%,且发病率逐年增高。在欧美一些国家,膀胱肿瘤的发病率也很高,在泌尿生殖系统中仅次于前列腺癌而居第二位。20XX年美国约有60240例新诊断的膀胱肿瘤病例,而浅表性膀胱癌约占新诊断病例的70%[1]。浅表性膀胱癌主要组织学类型为移行细胞癌,其他类型鳞状细胞癌和腺癌,均较少见。浅表性膀胱癌处理方法有:经尿道手术、激光手术、膀胱内灌注治疗、基因治疗、肿瘤疫苗等,应根据浅表性膀胱癌分期和预后因素来选择。浅表性膀胱癌基本治疗目标包括:去除存在的病灶、防止肿瘤复发和防止肿瘤复发后的进展。现将近年来浅表性膀胱癌治疗现状与进展综述如下。 关键词:浅表性膀胱癌;治疗 1 经尿道切除术(TUR) TUR是治疗表浅性膀胱癌的一种重要方法,主要适用于细胞分化好、直径小于2cm的Ta期和T1期肿瘤。该术式具有操作简单、所需时间短、不会造成腹壁种植、反复手术也不增加难度,患者的痛苦小、恢复快,保留了膀胱等优点,易为医生和患者接受。在正确选择手术适应症并熟练掌握手术技术的基础上,经尿道切除术可以获得与膀胱部分切除术相同的肿瘤术后复发率及患者生存率。但若仅单一采用TUR治疗,术后3~5年内复发率为50%~70%[2]。 对于Tis: TUR不能彻底切除肿瘤。早期膀胱切除具有很好的肿瘤特异生存。Huguet等[3]学者报道,在22例原位癌病例中,膀胱切除术5年特异性生存率达到80%,但会有40%-50%的过度治疗率[4]。因此在诊断原位癌后先行保守治疗还是早期膀胱切除术尚无统一意见。由于卡介苗(BCG)治疗失败的膀胱原位癌进展为肌肉浸润性癌是明显的,且与治疗失败的疗程数相关[5]。所以,膀胱根治术+尿流改道是BCG抵抗膀胱原位癌的标准治疗方法,但是手术时机尚缺乏可靠证据。 经尿道手术并发症少,主要是膀胱穿孔。注意控制膀胱灌注量,一般为 80ml~150ml,实际上以膀胱粘膜皱褶刚好消失为止。并注意预防闭孔神经反射,

3-膀胱癌诊断治疗指南2013修订版

膀胱癌诊断治疗指南 主编李宁忱北京大学吴阶平泌尿外科医学中心北京大学首钢医院 副主编谢立平浙江大学医学院附属第一医院 编委(按姓氏拼音排序) 陈凌武中山大学附属第一医院 董胜国青岛大学医学院附属医院 范欣荣中国医学科学院北京协和医学院(清华大学医学部)北京协和医院潘铁军广州军区武汉总医院 王忠上海交通大学医学院附属第九人民医院 魏东卫生部北京医院 徐可复旦大学附属华山医院 许传亮第二军医大学长海医院 许克新北京大学人民医院 秘书 宋毅北京大学泌尿外科研究所北京大学第一医院 目录 一、前言 二、膀胱癌的流行病学和病因学 三、膀胱癌的组织病理学 四、膀胱癌的诊断 五、非肌层浸润性膀胱癌的治疗 六、肌层浸润性膀胱癌的治疗 七、尿流改道术 八、膀胱癌的化疗与放疗 九、膀胱癌患者的生活质量、预后与随访 十、膀胱非尿路上皮癌

一、前言 膀胱癌是我国泌尿外科临床上最常见的肿瘤之一,是一种直接威胁患者生存的疾病。为了进一步规范膀胱癌诊断和治疗方法的选择,提高我国膀胱癌的诊断治疗水平,中华医学会泌尿外科学分会于2006年组织有关专家组成编写组,在学会委员会的直接领导与组织下,以国内外循证医学资料为依据,参考《吴阶平泌尿外科学》、Campbell’s Urology以及欧洲泌尿外科学会(EAU)、美国泌尿外科学会(AUA)、美国国立综合癌症网络(NCCN)等相关膀胱癌诊断治疗指南,结合国内临床实际,编写完成了2007年版中国《膀胱癌诊断治疗指南》,并在2009年进行了更新,为我国不同医疗条件下泌尿外科医师选择合理的膀胱癌诊断方法与治疗手段提供了有益的指导,对提高我国膀胱癌的诊治水平起到了巨大的推动作用。 两年来,随着膀胱癌诊断治疗相关研究的进展,使得《膀胱癌诊断治疗指南》又有了进一步更新的需要。在中华医学会泌尿外科学分会的统一领导安排下,《膀胱癌诊断治疗指南》编写组通过广泛征求意见,仔细查阅最新相关文献,并经过反复讨论,完成此版更新后的《膀胱癌诊断治疗指南》,以期对膀胱癌的临床诊断治疗工作提供更好的帮助。本版《膀胱癌诊断治疗指南》中共引用371条文献,其中由我国学者在国内或国际学术期刊中发表的论文共35条。

膀胱癌题库1-0-8

膀胱癌题库1-0-8

问题: [单选,A1型题]膀胱肿瘤的血尿特点() A.镜下血尿 B.终末血尿 C.间歇性无痛肉眼血尿,终末加重 D.血尿伴腰痛 E.血尿伴膀胱刺激症状

问题: [单选,A1型题]膀胱肿瘤最主要的诊断方法为() A.X线膀胱造影 B.膀胱镜检查必要时活检 C.尿脱落细胞学检查 D.超声波检查 E.膀胱区触诊

问题: [单选,A1型题]决定膀胱癌预后的是() A.肿瘤大小 B.肿瘤部位 C.肿瘤的单发多发 D.治疗方法 E.癌细胞分化程度和浸润深度以及机体的免疫能力 肿瘤的分化程度、临床分期、病理分级、大小、数目、手术方式、术后辅助放化疗、机体的免疫状态等因素均与膀胱癌的预后有关,其中最为重要的是癌细胞分化程度和浸润深度以及机体的免疫能力,故选E。 出处:安徽11选5 https://https://www.360docs.net/doc/7710998940.html,;

问题: [单选,A1型题]T2期膀胱肿瘤浸润的组织是() A.原位癌 B.黏膜固有层 C.浅肌层 D.深肌层 E.膀胱邻近组织 膀胱肿瘤浸润程度可分为:①Tis:原位癌。②Ta:乳头状无浸润。③T1:局限于黏膜固有层以内。 ④T2:浸润浅肌层。⑤T3:浸润深肌层或已穿透膀胱壁。⑥T4:浸润前列腺或膀胱邻近组织。综上所述,故选C。

问题: [单选,A1型题]膀胱肿瘤最常见的临床表现是() A.尿频、尿急、尿痛 B.疼痛+血尿 C.镜下血尿 D.排尿困难 E.全程肉眼血尿 血尿是膀胱肿瘤的主要症状,一般表现为全程血尿,终末加重。肿瘤侵犯膀胱三角区及合并感染或结石时可出现尿痛等膀胱刺激症状,盆腔广泛浸润时可出现腰骶部疼痛、下肢水肿等。因此选B。

非肌层浸润性膀胱癌

非肌层浸润性膀胱癌的治疗 非肌层浸润性膀胱癌(non muscle-invasive bladder cancer)或表浅性膀胱癌(superficial bladder cancer)占初发膀胱肿瘤的70%,其中T a占70%、T1占20%、T is占10%[1]。T a和T1虽然都属于非肌层浸润性膀胱癌,但两者的生物学特性有显著不同,由于固有层内血管和淋巴管丰富,故T1容易发生肿瘤扩散[2]。 某些因素同非肌层浸润性膀胱癌的预后密切相关。其中与复发密切相关的因素包括肿瘤数目、肿瘤的复发频率,尤其是术后3个月时有无复发、肿瘤大小、肿瘤分级。与肿瘤进展最相关的因素包括肿瘤的病理分级和肿瘤分期[3-7]。膀胱颈处的肿瘤预后较差[8]。根据复发风险及预后的不同,非肌层浸润性膀胱癌可分为以下三组: 1. 低危非肌层浸润性膀胱尿路上皮癌单发、T a、G1(低级别尿路上皮癌)、直径<3cm(注:必须同时具备以上条件才是低危非肌层浸润性膀胱癌)。 2. 高危非肌层浸润性膀胱尿路上皮癌多发或高复发、T1、G3(高级别尿路上皮癌)、T is。 3. 中危非肌层浸润性膀胱尿路上皮癌除以上两类的其他情况,包括肿瘤多发、T a~T1、G1~G2(低级别尿路上皮癌)、直径>3cm等。 欧洲膀胱癌指南根据EORTC评分表的肿瘤评分,将非肌层浸润性膀胱尿路上皮癌分为低危、中危和高危(参见九(二)《膀胱癌的预后因素》一节)。 (一)手术治疗 1.经尿道膀胱肿瘤切除术经尿道膀胱肿瘤切除术(TUR-BT)既是非肌层浸润性膀胱癌的重要诊断方法,同时也是主要的治疗手段。膀胱肿瘤的确切病理分级、分期都需要借助首次TUR-BT后的病理结果获得[9,10]。经尿道膀胱肿瘤切除术有两个目的:一是切除肉眼可见的全部肿瘤,二是切除组织进行病理分级和分期。TUR-BT术应将肿瘤完全切除直至露出正常的膀胱壁肌层。肿瘤切除后,建议进行基底部组织活检,便于病理分期和下一步治疗方案的确定。对于肿瘤切除不完全、标本内无肌层、高级别肿瘤和T1期肿瘤,建议术后2~6周再次行TUR-BT,可以降低术后复发概率[11,12]。 2.经尿道激光手术激光手术可以凝固,也可以汽化,其疗效及复发率与经尿道手术相近[13,14]。但术前需进行肿瘤活检以便进行病理诊断。激光手术对于

膀胱癌患者术后生活质量与社会支持的相关性研究

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浅表性膀胱癌的治疗现状与进展

浅表性膀胱癌的治疗现状与进展 (作者:___________单位: ___________邮编: ___________) 【关键词】浅表性膀胱癌;治疗 膀胱肿瘤是我国泌尿外科最常见的肿瘤,占全部恶性肿瘤的3.2%,且发病率逐年增高。在欧美一些国家,膀胱肿瘤的发病率也很高,在泌尿生殖系统中仅次于前列腺癌而居第二位。2004年美国约有60240例新诊断的膀胱肿瘤病例,而浅表性膀胱癌约占新诊断病例的70%[1]。浅表性膀胱癌主要组织学类型为移行细胞癌,其他类型鳞状细胞癌和腺癌,均较少见。浅表性膀胱癌处理方法有:经尿道手术、激光手术、膀胱内灌注治疗、基因治疗、肿瘤疫苗等,应根据浅表性膀胱癌分期和预后因素来选择。浅表性膀胱癌基本治疗目标包括:去除存在的病灶、防止肿瘤复发和防止肿瘤复发后的进展。现将近年来浅表性膀胱癌治疗现状与进展综述如下。 1 经尿道切除术(TUR) TUR是治疗表浅性膀胱癌的一种重要方法,主要适用于细胞分化好、直径小于2cm的Ta期和T1期肿瘤。该术式具有操作简单、所需时间短、不会造成腹壁种植、反复手术也不增加难度,患者的痛

苦小、恢复快,保留了膀胱等优点,易为医生和患者接受。在正确选择手术适应症并熟练掌握手术技术的基础上,经尿道切除术可以获得与膀胱部分切除术相同的肿瘤术后复发率及患者生存率。但若仅单一采用TUR治疗,术后3~5年内复发率为50%~70%[2]。 对于Tis: TUR不能彻底切除肿瘤。早期膀胱切除具有很好的肿瘤特异生存。Huguet等[3]学者报道,在22例原位癌病例中,膀胱切除术5年特异性生存率达到80%,但会有40%-50%的过度治疗率[4]。因此在诊断原位癌后先行保守治疗还是早期膀胱切除术尚无统一意见。由于卡介苗(BCG)治疗失败的膀胱原位癌进展为肌肉浸润性癌是明显的,且与治疗失败的疗程数相关[5]。所以,膀胱根治术+尿流改道是BCG抵抗膀胱原位癌的标准治疗方法,但是手术时机尚缺乏可靠证据。 经尿道手术并发症少,主要是膀胱穿孔。注意控制膀胱灌注量,一般为80ml~150ml,实际上以膀胱粘膜皱褶刚好消失为止。并注意预防闭孔神经反射,以减少膀胱穿孔发生。其他并发症如切除不完全、损伤膀胱颈、尿道。在与输尿管相近处手术宜电切不电凝,避免损伤输尿管口。后期并发症为膀胱挛缩、出血。 浅表性膀胱肿瘤经尿道切除术在具体应用时可根据病变情况、术者熟练程度、医院医疗条件选择,目前有经尿道膀胱肿瘤电切

2020高危非肌层浸润性膀胱癌诊疗的思考与展望

2020高危非肌层浸润性膀胱癌诊疗的思考与展望 膀胱癌是全球第十大常见恶性肿瘤,2018年中国新发膀胱癌患者82270例,发病率为5.8/10万[1]。其中,非肌层浸润性膀胱癌(NMIBC)占大多数,总体预后较为乐观,即使高危患者10年肿瘤特异性生存率也可达到70%~85%[2],但NMIBC的5年复发率高达31%~78%[3],给患者和社会带来了沉重的经济负担。 NMIBC 的生物学行为和表现 在生物学行为和临床表现上,高危NMIBC是一种异质性较强的肿瘤,不论是复发(31%~78%)抑或进展(0.8%~45%)的风险均存在较大变异度[4],这在一定程度上解释了既往T1期高危NMIBC临床研究中不同队列的临床治疗结果差异性较大。T1期NMIBC患者确诊后的5年死亡率达10~34%[5],因此这类肿瘤具有侵袭性并威胁患者生命。究其原因:其一,诊断因素,进行经尿道膀胱电切术(TURBT)或病理活检时,术者没有切到膀胱固有肌层,病灶体积过小或肿瘤基底烧灼导致病理诊断准确性受到影响等,以上因素导致T2期患者被低估,而误判为T1期患者进行治疗和预后分析;其二,肿瘤生物学因素,侵袭性的病灶难以完全切除,进而出现疾病进展[6](图1)。

图1:T1期NMIBC进展的可能机制[6] T1期膀胱癌治疗上最具挑战之处在于如何及时、准确地辨别及区分卡介苗(BCG)治疗期间可能出现复发和进展的患者,以及什么样的患者可以从早期根治性膀胱切除术中获益。尽管已有基于膀胱黏膜肌层浸润性情况的亚分期预后模型(如T1a/T1b/T1c),但这些模型并未在临床中广泛使用。对于具有侵袭倾向的T1期膀胱癌(例如二次电切时仍有T1期肿瘤,肿瘤脉管浸润,尿路上皮癌特殊组织学变异)需尽早进行膀胱癌根治性切除术。

膀胱癌的筛查和复发

膀胱癌的筛查和复发 在来源于上皮组织的膀胱癌中,约90%为移行上皮癌;非上皮性膀胱肿瘤较少见,主要包括未分化癌、鳞状细胞癌、腺癌,根据细胞的分化程度可将其分为3级。膀胱镜检查和尿细胞学检查被认为是膀胱肿瘤诊断的金标准。预计2012年美国膀胱癌新发病例数约七万例,一万余人死于膀胱肿瘤。其中,男性的发病率和死亡率均高于女性。浅表性膀胱癌早期诊断通常有较好的预后。然而,膀胱癌的复发率为60% ~70% ,居所有实体瘤的首位。11% 的复发患者会发展为浸润性膀胱癌,因此患者术后通常需每年进行3~4次膀胱镜检查。膀胱镜检查是侵人性检查,并发症多、花费较高,而这些问题需要通过对非侵入性的尿液检查的研究主要是改进传统的细胞学检验技术来解决。 1 尿细胞学检查 细胞学通常被视为膀胱癌初筛的金标准,Gareia等对109名患者进行的研究表明,单纯对尿样进行常规离心处理,作巴氏染色后进行细胞学检查就可以达到97% 的灵敏度和96%的特异度,且其中12例细胞学检验阳性而初次活检阴性的病人均在第二次活检时发现肿瘤,这一结果提示对于细胞学明确阳性的病人均应进行随访。但亦有研究指出对于I级,Ⅱ级,Ⅲ级的膀胱癌,

尿细胞学的灵敏度分别为5.8% ~25% ,24.0% ~40% ,50% ~88.9% ,特异度较高为99% ,提示尿细胞学检查对低级别膀胱癌灵敏度较差。 1.1 尿细胞学取样方法尿细胞学的取样方法主要有自然留尿和膀胱灌洗两种,通常取中段尿或膀胱灌洗液的中间部分作为细胞学标本来源。Badalamen等指出膀胱灌洗标本细胞学检查的灵敏度为6l% ,而自然留尿的灵敏度为41%;反复留尿三次灵敏度为60% ,仍低于单次膀胱灌洗细胞学检查。 1.2 尿细胞学制片方法尿细胞学制片分析方法主要有传统涂片和新近开展的液基细胞学技术,传统涂片读片时易被红细胞干扰,而液基细胞学技术可以去除干扰诊断的杂质制成背景清晰的液基细胞片,更好地保存细胞学形态,使得观察更为容易 J。液基细胞学包括液基薄层细胞学技术和液基沉降细胞学技术,前者是将采集的脱落细胞转移至含有保存液的特制小瓶中,通过过滤膜过滤将细胞和杂质分离,最终在玻片上制成直径为20 mm 的细胞薄层,固定后行巴氏染色,一次只能处理一份标本。后者是将脱落细胞和保存液通过比重液离心后,以自然沉淀的方法将标本中的可疑细胞与杂质分离,最终在玻片上制成直径为13 mm 的细胞薄层,可同时处理多份标本。然而,液基细胞学技术花费较高,且有研究指出液基薄层制片技术用于尿脱落细胞学检查,

无不良记录证明

无不良记录证明 ×××性别年龄身份证编号为我村居民,×××村委会特此证明。 年月日 签字公章 ×××性别年龄身份证编号 为我村居民,×××村委会特此证明。 年月日 签字 公章 南京市装饰行业管理办公室: 因业务工作需要,2015年度须行业管理部门出具《企业无不良记录证明》(以下称证明),并郑重承诺2015年至今未发生《证明》中建设部令第159号《建筑业企业资质管理规定》第二十一条情形之一: (一)超越本企业资质等级或以其他企业的名义承揽工程,或允许其他企业或个人以本企业的名义承揽工程的; (二)与建设单位或企业之间相互串通投标,或者以行贿等不正当手段谋取中标的; (三)未取得施工许可证擅自施工的; (四)将承包的工程转包或违法分包的; (五)违反国家工程建设强制性标准的;

(六)发生过较大生产安全事故或者发生过两起以上一般生产安全事故的; (七)恶意拖欠分包企业工程款或者农民工工资的; (八)隐瞒或谎报、拖延报告工程质量安全事故或者破坏事故现尝阻碍对事故调查的; (九)按照国家法律、法规和标准规定需要持证上岗的技术工种的作业人员未取得证书上岗,情节严重的; (十)未依法履行工程质量保修义务或拖延履行保修义务,造成严重后果的; (十一)涂改、倒卖、出租、出借或者以其他形式非法转让建筑业企业资质证书; (十二)其他违反法律、法规的行为。 以上报请出具的《证明》其真实性,公司已进行核实并经法定代表人认可。如有隐瞒、虚假、核实不清、骗取等行为的发生,本公司将在本年度内不再向行业管理部门报请任何证明文件的出具;并已获知行业管理部门将在本公司的《信用管理手册》中对上诉行为给予记载;公司将承担相应的法律责任并主动报请行业管理部门对本公司及主要责任人给予相应的处理。 公司名称 (盖章): 法定代表人(签字): 日期:年月日

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