Zhang Qi, Du Yanhua, Wang Dong, Du Gan, Cao Chuanzhen, Yu Xiaomin, Zhang Xiaoli, Xie Peipei, Wan Duo, Wen Li, Shi Hongzhe, Guan Youyan, Lu Li, Bi Xingang, Cheng Shujun, Zhang Kaitai, Zhang Wen, Shou Jianzhong
State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Urology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Cell Oncol (Dordr). 2025 Apr 29. doi: 10.1007/s13402-025-01059-4.
There is a lack of clinical evidence on whether further clinical strategies are needed after TURBT combined with immediate bladder instillation. This study intends to establish a reliable quantitative assay for active urinary cancer cells (AUCC) and to investigate the clinical efficacy of continuous saline bladder irrigation (CSBI) as a feasible option by analyzing the perioperative AUCC changes in TURBT.
An AUCC assay was developed and its reliability was verified by single-cell whole genome sequencing. Bladder cancer patients (N = 324) diagnosed by cystoscopy and pathologic biopsy and control individuals (N = 92) were included from 2021 to 2023 in the study. Enrolled patients with non-muscle invasive bladder cancer (NMIBC) underwent TURBT followed by immediate bladder instillation of epirubicin, after subgroups received CSBI or not, and AUCCs were tested on the first and fifth postoperative day. The patients were followed up for two years for postoperative recurrence.
The AUCC assay achieved good detection accuracy, with a sensitivity of 0.821 and specificity of 0.902. AUCC increased on the first day after TURBT in combination with immediate bladder instillation, regardless of whether or not the patient received CSBI. However, AUCCs decreased more rapidly on the fifth day in patients treated with CSBI, and patients with concomitant risk factors benefited more from CSBI. The two-year follow-up results showed that high-risk patients with complex surgeries could benefit significantly from CSBI.
We pioneered a quantitative assay for AUCC and provided laboratory evidence that TURBT causes tumor cell dissemination and CSBI can be a further clinical strategy to reduce the risk of potential recurrence.
对于经尿道膀胱肿瘤电切术（TURBT）联合即刻膀胱灌注后是否需要进一步的临床策略，目前缺乏临床证据。本研究旨在建立一种可靠的活性尿路上皮癌细胞（AUCC）定量检测方法，并通过分析TURBT围手术期AUCC的变化，探讨持续膀胱生理盐水灌注（CSBI）作为一种可行选择的临床疗效。
开发了一种AUCC检测方法，并通过单细胞全基因组测序验证了其可靠性。2021年至2023年期间，纳入了经膀胱镜检查和病理活检确诊的膀胱癌患者（N = 324）和对照个体（N = 92）。纳入的非肌层浸润性膀胱癌（NMIBC）患者接受TURBT，随后即刻膀胱灌注表柔比星，在亚组接受或不接受CSBI后，于术后第1天和第5天检测AUCC。对患者进行两年的术后复发随访。
AUCC检测具有良好的检测准确性，灵敏度为0.821，特异度为0.902。无论患者是否接受CSBI，TURBT联合即刻膀胱灌注后第1天AUCC均升高。然而，接受CSBI治疗的患者在第5天AUCC下降更快，伴有危险因素的患者从CSBI中获益更多。两年随访结果显示，复杂手术的高危患者可从CSBI中显著获益。
我们开创了一种AUCC定量检测方法，并提供了实验室证据，表明TURBT会导致肿瘤细胞播散，而CSBI可以作为一种进一步的临床策略来降低潜在复发风险。
