Studies On Tumor Marker And Multidrug Resistance In Bladder Cancer

Bladder transitional cell carcinoma (BTCC) is the most common cancer of genitourinary tract in our country, and does serious harm to health. Despite of the improvements of operational skills and chemotherapeutic agents, the recurrent rate of bladder cancer still keeps at 50%-70% after initial treatment. Simple detective method with high specificity and supersensitivity is the key to elongate the survival time without tumor and improves the life quality of people suffered from bladder cancer. Our studies include two parts: The first one is the comparison of three non-invasive methods for detection of bladder cancer, and the other is the study of drug resistance mediated by fibronectin in the chometherapy of bladder cancer. Our objective is to explore some new and simple methods with high specificity and supersensitivity for the detection of BTCC, and to provide the basis of investigation for enhancing the sensitivity of BTCC to the chemotherapeutic agents.Part OneComparison of the NMP22 test, DNA content analysis with flow cytometry and cytology for the detection of bladder cancer.Background:Cystoscopy aided by biopsy and cytology are the main methods for detection of bladder cancer in our clinical experiences. Cytoscopy is invasive and expensive, and in some cases, carcinoma in situ may appear grossly normal under cystoscopy. Although with high specificity, voided urine cytology lacks sensitivity to low grade tumors. Objective:To compare and evaluate three methods for the detection of BTCC, NMP22 , DNA content analysis with flow cytometry and voided urine cytology. Methods:85 patients were divided into four groups, bladder transitional cell carcinoma, benign diseases of urinary system, no-urothelium malignancy of urinary system and inverted urothelial papilloma of bladder. Every patient was asked to submit a single voided urine sample before operation. Each sample was divided into 3 aliquots, and NMP22, FCM, cytological examination were performed respectively. The positive and negative predictive value, sensitivity and specificity of the three non-invasive methods were compared. Results:Median NMP22 values of BTCC group, benign disease group, no-urothelium malignancy group and inverted urothelial papilloma group were 16.1U/ml,6.4U/ml, 4.5U/ml, 6.4U/ml respectively. The urinary NMP22 values in the BTCC group were significantly higher than those in benign disease group, no-urothelium malignancy group (PO.05). However, the NMP22 values in BTCC group had no significantly difference compared with those in inverted urothelial papilloma group. Sensitivity of NMP22, FCM, and cytology for diagnosis of BTCC were 61.1%, 69.4% and 18.3%, the specificity were 67.4%, 59.2% and 100%, the positive predictive values were 57.9%, 55.6% and 100%, and the negative predictive values were 70.2%, 72.5% and 62.8% respectively. Conclusions:1. The value of urinary NMP22 in patients with BTCC increases, and NMP22 is a new marker of BTCC.2. Urinary NMP22 assay and FCM have higher sensitivity than cytology, and which may represent a useful diagnostic adjunct for the detection of BTCC.3. Combination of MNP22 and FCM can increase the detection rate of BTCC.