The Value Of FISH Technology In Monitoring For The Recent Recurrence Of Bladder Cancer After TURBT

Background:Bladder cancer, the most common malignant cancer in urinary system,has a higher rate of progress and the recurrence rate,the incidence and mortality of it are the first in all the urogenital system carcinoma. The incidence of male patients with relatively high incidence of female patients, the ratio of the incidence of about 3:1. Non-invasive bladder cancer is predominant type in the new cases, stage mainly for Tis, Ta, T1 (about 70%), and there are more than half of all cases relapse within five years, a third of the cases develop into infiltrating type. The higher grade malignant is, the more easily it progress. Now transurethral resection of bladder tumor (TURBT) and postoperative bladder perfusion chemotherapy drugs local chemotherapy and regular monitoring of tumor recurrence are the main therapies for this kind of non invasive superficial bladder cancer and some of the T2a period is the treatment of patients with high-risk factors. And the main means and methods of monitoring with microscopic examination of the bladder, urine loss cytologic examination and imaging examination, such as urinary tract CT. But it is hard for cystoscope and radiographic inspection to find clinically insignificant morphologic changes of tumor or carcinoma in situ,to diagnosis this part of the tumor. And cystoscopy as the main means of a recurrence monitoring is an invasive examination, bringing discomforts、 pains and some corresponding risk of complications to the patient. Fall off urine cytology inspection identifying markers plays an important role in diagnosing and monitoring the recurrence of bladder cancer, it has higher specificity but less sensitivity, especially for patients with low grade of bladder tumor the sensitivity is lower. And law is common in patients with bladder cancer postoperative bladder perfusion therapy, chemotherapy drugs can cause tissue inflammation reaction to a certain extent, thus interference cystoscope and peeling urine cytology results. In recent years the study of bladder.tumor found that lesions in the no.3, no.7, no.17 and P16 cell chromosome number and structure of anomaly loci change or all of the leakage is the most common genetic changes. This change is closely related to bladder cancer in the early. Fluorescence In Situ Hybridization (Fluorescence In Situ Hybridization, FISH) technology based on cytogenetics detection technology is one of the main research methods of molecular cytogenetics, in recent years,it is used in the research of distortion of the chromosome number and structure.FISH test morning urine exfoliated cells of patients, the value of FISH in diagnosing of bladder urothelial tumors and its application has now been widely confirmed and affirmed, the test technology constantly development and promotion, now already in clinical has become an important check method of bladder cancer in the preoperative Li broken, but the accounts for its used in monitoring the curative effect and recurrence after treatment is rare, so it is necessary to study the value of FISH detection technique in monitoring the recent postoperative recurrence of bladder TURBT.Objective:At present, microscopic examination of the bladder, urine cytology test as the two main means of bladder cancer postoperative follow-up test, microscopic examination of the bladder is a kind of means which brings discomforts and some risk of complications to patients, the sensitivity of urine cytology test is low, especially more lower for low-level sensitive bladder. FISH technology can be used as a new means in diagnosing bladder cancer, it is less noninvasive and more sensitive than microscopic examination of the bladder and urine cytology test.Investigating the value of FISH technique in monitoring recent recurrence of bladder cancer after the transurethral bladder cancer electricity cut, this experiment provides new means of bladder cancer postoperative follow-up.Methods:50 bladder cancer patients who had TURBT during June 2013 to June 2014 in Yangtze university affiliated hospital —Jingzhou NO.1 Hospital urinary surgical department were chosen for this experiment.Within 12 months after TURBT, patients do FISH test, cystoscopy and urine cytology every three months. In these cases,one of the three tests results in positive can be as the starting point for follow-up observation, while patients results positive in cystoscopy and urine cytology test can be as the end point of the follow-up observation. Comparative analysis with statistical software bladder after examination, urine cytology, FISH examination detection rate and detection time, thus judges FISH technology used to monitor the transurethral bladder cancer electricity cut the value of postoperative recurrence of recent.Results:In this study, there are 50 post-TURBT patients had FISH、cystoscopy and urine cytology test, the results show that, in the 50 cases of cystoscopy and urine in patients with positive cytology is determined for patients who relapse in 3 cases (6.00%). Of the 50 patients underwent FISH examination, FISH examination of positive results in patients with a total of 7 cases (14.00%). Through the positive results cystoscopy and cytology determination for 3 cases of recurrence of the patients, 1 patients in the postoperative ninth months to determine recurrence,2 patients in twelfth months after operation to determine recurrence, average recurrence time (in this experiment by cystoscopy and positive as criteria for (recurrence) 11+4.30) months. Through the FISH test results appear positive in 7 cases of patients, third months after operation were detected in 48 patients, positive results of patients was 0 cases; sixth months after operation were detected in 50 patients, positive results of patients was 1 cases; Ninth months after operation were detected in 49 patients, among them the positive results of the patients was 3 cases; twelfth months after operation were detected in 46 patients, positive results for 6 cases of patients, the findings of FISH and mean time to detection of positive for (10.28+2.18) months. Results 7 cases in FISH positive patients are included 3 cases of cystoscopy and cytology with positive is determined in patients with relapse. In 1 patients sixth months after surgery, and after the 2 FISH consecutive tests were all positive, this patient cystoscopy and cytology positive determining recurrence time of ninth months after surgery; 1 patients were positive in ninth months after operation and twelfth months after surgery. FISH examination, the patient with cystoscopy and cytology positive determining recurrence time of twelfth months after surgery; 1 patients at twelfth months postoperatively in FISH examination showed positive results, the patients with cystoscopy and cytology positive determining recurrence time was twelfth months after operation; 1 cases patients at ninth months postoperatively in FISH examination showed positive results, FISH examination of 3 patients in twelfth months after operation in 4 patients showed positive results, the bladder in this experimental research of microscopic examination and urine cytology was negative, judged as non recurrence. Statistical analysis of experimental data, the t test showed that the average detection time of FISH testis lower than that of cystoscopy (P< 0.05).Conclusion:To monitor the recent recurrence of the bladder cancer patients after transurethral electric cutting, currently,cystoscopy is the main means, however,it is a kind of invasive examination which can bring much pain to the patient and increase the risk of complications such as intraoperative bleeding, postoperative infection,and local tissue injury, and the more times cystoscopy have a to the pain of patients and increased risk. FISH, is a noninvasive, safe and convenient means of inspection, although this study was unable to confirm that FISH test is an alternative one of cystoscopy in monitoring the TURBT recent postoperative recurrence of bladder cancer, but the experimental study shows that the positive time in average of FISH test is under those of cystoscopy; recurrence rate of positive patients who were examined by FISH is higher than that of cystoscopy and urine cytology test or negative patients who were examined by FISH. FISH test can be earlier in time to apply intervention treatment to the recurrent bladder cancer patients after TURBT than that of the bladder microscopy test,it can be an effective method in monitoring for those postoperative patients.