The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Urol Oncol. 2012 Jan-Feb;30(1):44-8. doi: 10.1016/j.urolonc.2009.10.008. Epub 2009 Dec 16.
Due to imprecise clinical staging, the finding of extravesical and node-positive disease at the time of radical cystectomy (RC) for patients with clinically localized bladder cancer is not uncommon. Circulating tumor cells (CTCs) have been shown to be present in the peripheral blood of patients with metastatic urothelial carcinoma. The object of this study was to evaluate the ability of CTCs to predict extravesical disease in bladder cancer patients prior to RC.
Peripheral blood samples from 43 patients with bladder cancer were evaluated using the CellSearch (Veridex, LLC, Raritan, NJ) CTC assay prior to RC. The sensitivity, specificity, and positive predictive value (PPV) of CTC status in predicting extravesical disease was calculated. Receiver operating characteristic (ROC) curves were generated to quantify the ability of CTCs to predict extravesical and node-positive disease.
CTCs were detected in 9 (21%) patients prior to RC. The sensitivity, specificity, and PPV of CTC status in predicting extravesical disease were 27%, 88% and 78%, respectively. The accuracy of CTC status in predicting extravesical (≥pT3 or node-positive) disease for the entire cohort was 0.576. In a model incorporating preoperative hydronephrosis, CTC status did not improve the predictive accuracy for extravesical disease (0.576 vs. 0.585, P = 0.915).
CTCs were detected in low numbers in a small percentage (21%) of patients prior to undergoing RC at our institution. CTC status was not a robust predictor of extravesical or node-positive disease in this cohort. CTC status is not likely to be a clinically useful parameter for directing therapeutic decisions in patients with ≤cT2 bladder cancer.
由于临床分期不精确，在对临床局限性膀胱癌患者进行根治性膀胱切除术 (RC) 时，发现膀胱外和淋巴结阳性疾病并不罕见。已经表明，循环肿瘤细胞 (CTC) 存在于转移性尿路上皮癌患者的外周血液中。本研究的目的是评估 CTC 在 RC 前预测膀胱癌患者膀胱外疾病的能力。
在 RC 前，使用 CellSearch（Veridex，LLC，Raritan，NJ）CTC 检测了 43 例膀胱癌患者的外周血样本。计算了 CTC 状态预测膀胱外疾病的敏感性、特异性和阳性预测值 (PPV)。生成了接收器工作特性 (ROC) 曲线，以量化 CTC 预测膀胱外和淋巴结阳性疾病的能力。
RC 前在 9 例（21%）患者中检测到 CTC。CTC 状态预测膀胱外疾病的敏感性、特异性和 PPV 分别为 27%、88%和 78%。CTC 状态预测整个队列膀胱外（≥pT3 或淋巴结阳性）疾病的准确性为 0.576。在包含术前肾积水的模型中，CTC 状态并未提高预测膀胱外疾病的准确性（0.576 与 0.585，P=0.915）。
在本机构进行 RC 前，少量（21%）患者中检测到低数量的 CTC。CTC 状态不是该队列中膀胱外或淋巴结阳性疾病的可靠预测因子。在≤cT2 膀胱癌患者中，CTC 状态不太可能成为指导治疗决策的临床有用参数。
