背景:膀胱癌(UBC)是影响泌尿系统的最常见恶性肿瘤。本研究旨在探讨尿沉渣中DAPK甲基化与B超联合检测对复发性UBC的诊断价值。
方法:共纳入1021例经尿道电切膀胱肿瘤的原发性UBC患者,并进行随访。各种参数,包括B超,尿沉渣中的DAPK甲基化,检查尿液中脱落的细胞,并进行膀胱镜检查。收集的数据使用Kappa检验进行分析,并构建受试者工作特征(ROC)曲线以评估在复发性UBC中的诊断作用。
结果:在1021名患者中,115例患者在两年内经膀胱镜检查和活检证实复发,并被排除在研究之外。导致906例主要UBC病例的有效样本量。膀胱镜检查结果与B超结果一致(Kappa=0.785,P<0.05),以及尿沉渣中的DAPK甲基化,并联合B超和DAPK甲基化(Kappa=0.517,P<0.05,Kappa=0.593,P<0.05)。B超联合DAPK甲基化后曲线下面积为0.922,灵敏度为92.86%,特异性91.63%,阴性预测值为99.4%,提示阴性结果提示复发风险较低.
结论:尿沉渣中DAPK甲基化联合B超对复发性UBC具有较高的诊断效能。
BACKGROUND: Urinary bladder cancer (UBC) is the most common malignancy affecting the urinary system. This study aimed to investigate the diagnostic value of combining DAPK methylation in urinary sediment and B ultrasound in the detection of recurrent UBC.
METHODS: A total of 1021 cases with primary UBC who underwent electrocision of bladder tumor through urethra were included in this study and followed up. Various parameters including B ultrasound, DAPK methylation in urinary sediment, examination of exfoliated cells in the urine, and cystoscopy were performed. The data collected was analyzed using the Kappa test, and receiver operating characteristic (ROC) curve was constructed to assess the diagnostic role in recurrent UBC.
RESULTS: Among the 1021 patients, 115 patients experienced recurrence confirmed by cystoscopy and biopsy within two years and were excluded from the study, resulting in an effective sample size of 906 primary UBC cases. The results of cystoscopy showed agreement with B ultrasound (Kappa = 0.785, P < 0.05), as well as with DAPK methylation in urinary sediment, and the combination of B ultrasound and DAPK methylation (Kappa = 0.517, P < 0.05, Kappa = 0.593, P < 0.05). The combination of B ultrasound with DAPK methylation yielded an area under the curve of 0.922, with a sensitivity of 92.86%, specificity of 91.63%, and a negative predictive value of 99.4%, suggesting that a negative result indicates a low risk of recurrence.
CONCLUSIONS: The combination of DAPK methylation in urinary sediment with B ultrasound demonstrates high diagnostic performance for recurrent UBC.