【摘要】 目的:探讨尿液中循环肿瘤DNA(circulating tumour DNA,ctDNA)水平在非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer, NMIBC)术后预测复发及进展中的临床价值。方法:选取2017年06月至2019年06月在我院收治的膀胱癌患者96例，均接受经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT),且术后病检均证实为非肌层浸润性膀胱尿路上皮癌。根据术后病检结果分为两组：A组：高级别NMIBC患者46例，B组：低级别NMIBC患者50例。术后每个月测定患者尿液中ctDNA的水平，每3个月复查泌尿系彩超、膀胱镜及尿脱落细胞学检查，每6个月复查膀胱CT;所有患者术后均进行随访，随访期18个月，影像学或膀胱镜检查证实肿瘤临床复发或进展为肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)时即停止随访。结果:在随访期内共有62例患者通过膀胱镜检查或影像学手段证实肿瘤出现了复发或进展，其中A组有36例，B组有26例，两组间差异具有统计学意义(P <0.05);在肿瘤复发或进展的62例患者中，A组尿液ct DNA阳性患者27例，B组尿液ct DNA阳性患者21例，差异无统计学意义(P> 0.05);两组共有63例患者在影像学及膀胱镜检查有异常之前首先从尿液中检测到了ct DNA，其中48例患者在之后的随诊复查中证实肿瘤出现了复发或进展;肿瘤进展组患者尿液中ct DNA水平显著高于复发组，差异具有统计学意义(P <0.05)。结论:通过液态活检技术动态检测NMIBC术后患者尿液中ct DNA的水平，能更早地发现肿瘤的复发及进展，具有较高的特异性，而且与肿瘤进展存在一定的相关性，可能成为NMIBC术后辅助监测肿瘤早期复发或进展的新手段。更多还原

【Abstract】 Objective:To explore the clinical value of urine circulating tumor DNA(ctDNA) level in predicting recurrence and progression of non-muscular-invasive bladder cancer(NMIBC)after operation.Methods:A total of 96 patients with bladder cancer treated in our hospital from June 2017 to June 2019 were selected.All patients underwent transurethral resection of bladder tumor(TURBT),and all of them were confirmed as non-muscular-invasive bladder urothelial carcinoma by postoperative pathological examination.According to the results of postoperative pathological examination, the patients were divided into two groups: group A(n=46) with high-grade NMIBC and group B(n=50) with low-grade NMIBC.The level of ctDNA in urine was measured every month after operation.Urinary color ultrasound, cystoscopy and urine exfoliative cytology were examined every 3 months.All patients with bladder CT were followed up every 6 months.The follow-up period was 18 months.The follow-up was stopped when imaging or cystoscopy confirmed that the tumor had clinical recurrence or progression to muscular-invasive bladder cancer(MIBC).Results:During the follow-up period, a total of 62 patients were confirmed to have tumor recurrence or progression by cystoscopy or imaging, including 36 cases in group A and 26 cases in group B,and the difference was statistically significant between the two groups(P<0.05).Among the 62 patients with tumor recurrence or progression, there were 27 patients with positive urine ctDNA in group A and 21 patients with positive urine ctDNA in group B,and there was no significant difference between the two groups(P>0.05). A total of 63 patients in the two groups first detected ctDNA,in their urine before having abnormalities in imaging and cystoscopy, of which 48 patients were confirmed to have tumor recurrence or progression in subsequent follow-up.The level of ctDNA in urine of patients with tumor progression was significantly higher than that of patients with recurrence, and the difference was statistically significant between the two groups(P<0.05).Conclusion:Dynamic detection of ctDNA level in urine of patients after NMIBC by liquid biopsy technique can detect tumor recurrence and progression earlier, with high specificity, and has a certain correlation with tumor progression, so it may become a new method to assist in monitoring early tumor recurrence or progression after operation of NMIBC.更多还原