Pycha Armin, Lodde Michele, Comploj Evi, Negri Giovanni, Egarter-Vigl Eduard, Vittadello Fabio, Lusuardi Lukas, Palermo Salvatore, Mian Christine
Department ofUrology, General Hospital of Bolzano, Bolzano, Italy.
Urology. 2004 Mar;63(3):472-5. doi: 10.1016/j.urology.2003.10.020.
To perform a biologic characterization of the urothelial neoplasms of patients in the intermediate-risk group using multicolor-fluorescence in situ hybridization (FISH). A general consensus has not been reached with regard to the optimal therapy and follow-up of patients with urothelial neoplasms at intermediate risk of progression. On the basis of the chromosomal pattern, we developed a new follow-up algorithm for this group and report our preliminary results.
Voided urine samples of 51 consecutive patients (mean age 72.2 years, range 52 to 93) under follow-up after complete transurethral resection of intermediate-risk urothelial carcinoma were evaluated by liquid-based cytology (ThinPrep) and uCyt+. From the residual material, Multicolor-FISH (Urovysion) was performed. Any cystoscopically suspicious lesion was biopsied or removed transurethrally. The mean follow-up time was 14.2 months (range 6 to 30, SD 5.5).
Two of the 51 patients were not evaluated because of the presence of intense granulocytosis and insufficient urothelial cells. Of the 49 remaining patients, the results of the Multicolor-FISH analysis were negative (diploid chromosomal pattern) in 14; 20 patients showed the loss of one or both alleles of p16 and/or an aneuploidy of chromosome 3, and 15 patients had aneuploidy of chromosome 7 and/or 17. Of the 14 FISH-negative patients, 2 (14.3%) had histologically verified recurrence, and 3 (15.0%) of the 20 p16/3-positive patients had recurrence and 9 (60.0%) of the 15 7/17-positive patients had either recurrence or progression.
Using the Urovysion test, it is possible to predict the biologic behavior of urothelial cancer with a significant impact on the follow-up of patients. The intermediate-risk group of urothelial cancer can be eliminated in the routine workup by classifying these patients according to their chromosomal pattern and defining those patients who can follow the low-risk scheme and those who must be monitored according to the guidelines for high-risk superficial lesions.
运用多色荧光原位杂交（FISH）技术对中危组患者的尿路上皮肿瘤进行生物学特征分析。对于中危进展期尿路上皮肿瘤患者的最佳治疗及随访方案，目前尚未达成普遍共识。基于染色体模式，我们为该组患者制定了一种新的随访算法并报告初步结果。
对51例连续患者（平均年龄72.2岁，范围52至93岁）在完全经尿道切除中危尿路上皮癌后进行随访，其排尿后的尿液样本采用液基细胞学（ThinPrep）和uCyt + 进行评估。从剩余材料中进行多色FISH（Urovysion）检测。任何膀胱镜检查可疑病变均进行活检或经尿道切除。平均随访时间为14.2个月（范围6至30个月，标准差5.5）。
51例患者中有2例因存在严重粒细胞增多症且尿路上皮细胞不足而未进行评估。在其余49例患者中，多色FISH分析结果为阴性（二倍体染色体模式）的有14例；20例患者显示p16一个或两个等位基因缺失和/或3号染色体非整倍体，15例患者有7号和/或17号染色体非整倍体。在14例FISH阴性患者中，2例（14.3%）经组织学证实复发，在20例p16/3阳性患者中有3例（15.0%）复发，在15例7/17阳性患者中有9例（60.0%）复发或进展。
使用Urovysion检测可以预测尿路上皮癌的生物学行为，这对患者的随访有重大影响。通过根据染色体模式对中危组尿路上皮癌患者进行分类，并确定哪些患者可遵循低危方案以及哪些患者必须按照高危浅表病变指南进行监测，可以在常规检查中消除该组患者。
