Yang S C, Lee D H, Hong S J, Chung B H, Kim I Y
Department of Urology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1997 Jun;38(3):155-9. doi: 10.3349/ymj.1997.38.3.155.
The enzyme telomerase maintains a constant telomere length in immortalized cells, allowing unlimited cell proliferation. Almost all cancer cells express telomerase activity. However, little data is available regarding the role of telomerase activity in the detection of bladder cancer with a bladder wash specimen. We detected telomerase activity in a bladder wash specimen of bladder cancer and normal tissues, and compared them with final pathologic diagnosis. Twenty-three patients with transitional cell carcinoma (TCC) of the bladder were enrolled in our study. A bladder wash specimen was obtained before transurethral resection of the bladder (TURB) and normal and cancer tissues from the same patients during TURB. Telomerase activity was analyzed in each specimen a using telomeric repeat amplification protocol (TRAP) assay based on polymerase chain reaction (PCR) technique. Cytologic diagnosis was performed using Papanicolaou's stain with cytocentrifuged cytology preparation. We observed telomerase activity in 95.7% (22/23) of bath cancer tissues and bladder wash specimens; only one case did not express telomerase activity. Telomerase activity was undetected in all normal tissues except one, which was obtained from a patient with carcinoma in situ. A total of 69.6% (16/23) of wash specimens were positive in cytopathologic diagnosis. The accuracy of cytopathologic diagnosis in pathologic grade 2 or 3 was relatively high (83.3%, 15/18). However, in five cases of grade 1 TCC only 20% (1/5) of cytologic diagnosis was positive whereas the telomerase activity of wash specimens was detected in 80% (4/5). Our data demonstrates that not only the majority of human bladder cancer tissues, but also the bladder wash specimens obtained from patients with TCC, expressed telomerase activity. It indicates that telomerase activity may be a reliable marker in detecting bladder cancer especially in cases with a low grade that bladder wash cytology can miss.
端粒酶可维持永生化细胞中端粒长度恒定，从而使细胞能够无限增殖。几乎所有癌细胞都表达端粒酶活性。然而，关于端粒酶活性在膀胱冲洗标本检测膀胱癌中的作用，目前可用数据较少。我们检测了膀胱癌及正常组织膀胱冲洗标本中的端粒酶活性，并将其与最终病理诊断结果进行比较。23例膀胱移行细胞癌（TCC）患者纳入本研究。在经尿道膀胱肿瘤切除术（TURB）前获取膀胱冲洗标本，并在TURB期间获取同一患者的正常组织和癌组织。使用基于聚合酶链反应（PCR）技术的端粒重复序列扩增法（TRAP）检测各标本中的端粒酶活性。采用巴氏染色法对细胞离心涂片进行细胞学诊断。我们观察到，95.7%（22/23）的膀胱癌组织和膀胱冲洗标本中存在端粒酶活性；仅1例未表达端粒酶活性。除1例原位癌患者的正常组织外，所有正常组织均未检测到端粒酶活性。细胞病理学诊断中，共有69.6%（16/23）的冲洗标本呈阳性。病理2级或3级的细胞病理学诊断准确性相对较高（83.3%，15/18）。然而，在5例1级TCC中，细胞学诊断阳性率仅为20%（1/5），而冲洗标本的端粒酶活性检测阳性率为80%（4/5）。我们的数据表明，不仅大多数人膀胱癌组织，而且TCC患者的膀胱冲洗标本也表达端粒酶活性。这表明端粒酶活性可能是检测膀胱癌的可靠标志物，尤其是在膀胱冲洗细胞学检查可能漏诊的低级别病例中。
