Droller M J, Kavaler E, Landman J, Liu B C
Department of Urology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Keio J Med. 1998 Sep;47(3):135-41. doi: 10.2302/kjm.47.135.
Voided urine from patients with bladder cancer and from control patients with either hematuria or with no urologic conditions were examined for telomerase activity in order to explore the possibility that this activity could be used as a marker for the detection of bladder cancer. This assay was found to have an overall sensitivity in detecting bladder cancer of 85% (88/104) with 79% (23/29) grade 1 tumors, 84% (32/38) grade 2 tumors, 87.5% (28/32) grade 3 tumors, and 100% (5/5) carcinoma in situ testing positive. This compared favorably with urinary cytology which had an overall sensitivity of 51% and sensitivities of 13%, 44%, 82%, and 100% for grades 1, 2, 3 tumors and carcinoma in situ, respectively. The specificity of telomerase in patients with benign causes of hematuria was 66%, and in normal volunteers without urologic conditions, it was 100%. Assessment of nuclear matrix protein suggested comparable sensitivity and specificity. Evaluation of bladder tumor antigen showed less sensitivity for low-grade disease and less specificity, as it was influenced by inflammation and instrumentation. Telomerase thus seems to be a means whereby low-grade tumors may be detected in examination of voided urine and may offer an advantage in monitoring for recurrent disease.
对膀胱癌患者以及患有血尿或无泌尿系统疾病的对照患者的晨尿进行端粒酶活性检测，以探索该活性用作膀胱癌检测标志物的可能性。结果发现，该检测方法检测膀胱癌的总体敏感性为85%（88/104），其中1级肿瘤的敏感性为79%（23/29），2级肿瘤为84%（32/38），3级肿瘤为87.5%（28/32），原位癌检测阳性率为100%（5/5）。这与尿细胞学检查相比具有优势，尿细胞学检查的总体敏感性为51%，1级、2级、3级肿瘤和原位癌的敏感性分别为13%、44%、82%和100%。血尿良性病因患者中端粒酶的特异性为66%，无泌尿系统疾病的正常志愿者中为100%。核基质蛋白评估显示出相当的敏感性和特异性。膀胱肿瘤抗原评估显示对低级别疾病的敏感性较低且特异性较差，因为它受炎症和器械操作的影响。因此，端粒酶似乎是一种在晨尿检查中可检测低级别肿瘤的方法，并且在监测复发性疾病方面可能具有优势。
