Xu Ben, Zhang Jia-En, Ye Lin, Yuan Chang-Wei
Department of Urology, Peking University First Hospital, Beijing, China.
Front Oncol. 2023 Jul 27;13:1225428. doi: 10.3389/fonc.2023.1225428. eCollection 2023.
To evaluate the clinical utility of voided urine fluorescence hybridization (FISH) for predicting the pathology of preoperative "low-risk" upper tract urothelial carcinoma (UTUC).
Information of patients preoperatively diagnosed with "low-risk" UTUC receiving radical nephroureterectomy (RNU) between May 2014 and October 2019 were retrospectively collected. All of the patients accepted the FISH test and then were divided into two groups according to the results of FISH. The diagnostic value of FISH was assessed through the receiver operating characteristics (ROC) curve and area under the curve. Logistic regression analysis was applied to examine FISH as a predictive factor of tumor final stage and grade of preoperative "low-risk" UTUC.
In total, 129 patients were included. Of them, 70 (54.2%) were marked with positive FISH result. The difference at final pathology in tumor stage and tumor grade between these two groups of FISH (-) and FISH (+) had significantly statistical significance (p<0.001). Regarding to the tumor stage at final pathology, the sensitivity, specificity, positive predictive value and negative predictive value of FISH were 70.7 (58.9-80.3)68.5 (54.3-80.1)75.7 (63.7-84.8) and 62.7 (49.1-74.7), respectively. Regarding to the tumor grade at final pathology, the sensitivity, specificity, positive predictive value and negative predictive value of FISH were 64.7 (53.5-74.6), 65.9 (50.0-79.1), 78.6 (66.8-87.1) and 49.1 (36.5-62.3), respectively. The results of logistic regression analysis indicated that FISH could predict the pathologic characteristics of preoperative "low-risk" UTUC independently.
FISH was qualified with relatively high diagnostic estimates for predicting tumor stage and grade of preoperative "low-risk" UTUC, and could be an independent predictive factor in clinical practice. For preoperative "low-risk" UTUC patients but with positive FISH result, choosing nephron-sparing surgery may require special caution.
评估排尿尿液荧光原位杂交（FISH）对术前“低风险”上尿路尿路上皮癌（UTUC）病理情况的预测临床效用。
回顾性收集2014年5月至2019年10月期间术前诊断为“低风险”UTUC并接受根治性肾输尿管切除术（RNU）的患者信息。所有患者均接受FISH检测，并根据FISH结果分为两组。通过受试者工作特征（ROC）曲线及曲线下面积评估FISH的诊断价值。应用逻辑回归分析检验FISH作为术前“低风险”UTUC肿瘤最终分期和分级预测因素的情况。
共纳入129例患者。其中，70例（54.2%）FISH结果为阳性。FISH（-）组和FISH（+）组在肿瘤最终病理分期和分级方面的差异具有显著统计学意义（p<0.001）。对于最终病理的肿瘤分期，FISH的敏感性、特异性、阳性预测值和阴性预测值分别为70.7（58.9 - 80.3）、68.5（54.3 - 80.1）、75.7（63.7 - 84.8）和62.7（49.1 - 74.7）。对于最终病理的肿瘤分级，FISH的敏感性、特异性、阳性预测值和阴性预测值分别为64.7（53.5 - 74.6）、65.9（50.0 - 79.1）、78.6（66.8 - 87.1）和49.1（36.5 - 62.3）。逻辑回归分析结果表明，FISH可独立预测术前“低风险”UTUC的病理特征。
FISH对术前“低风险”UTUC的肿瘤分期和分级具有较高的诊断评估价值，且在临床实践中可能是一个独立的预测因素。对于术前“低风险”UTUC患者但FISH结果为阳性者，选择保留肾单位手术可能需要特别谨慎。
