Text/Yangcheng Evening News all-media reporter Li Gang
Through more than ten years of research, it has achieved four major improvements in the minimally invasive and accurate diagnosis and treatment of bladder cancer in China. At the Provincial Science and Technology Innovation Conference held on April 15, "Establishment and Promotion and Application of Minimally Invasive And Accurate Diagnosis and Treatment System for Bladder Cancer" won the first prize of Guangdong Provincial Science and Technology Progress Award.
According to Lin Tianxin, project leader and vice president of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, the incidence of bladder cancer ranks sixth in malignant tumors and first in urinary tumors. However, there is a low rate of early diagnosis, small lesions are easy to miss diagnosis, the early diagnosis rate is only 32%; the staging is not accurate, the diagnosis rate of lymphatic metastasis is only 50%; the surgical trauma is large, the open surgical incision is large, and the sexual function preservation rate is only 10%; the mortality rate of patients in the middle and advanced stages is high, and the 5-year survival rate is less than 40%. Therefore, improving the level of diagnosis and treatment of bladder cancer is an urgent clinical problem and demand in mainland China.
The establishment of this system has made innovative contributions to the accurate qualitative localization diagnosis of bladder cancer, the accurate preoperative staging diagnosis, the minimally invasive surgical robot for functional preservation, and the new targeted drug therapy. The system finally achieved four improvements in the minimally invasive and accurate diagnosis and treatment of bladder cancer in China, the early diagnosis rate increased from 32% to 79%, the staging accuracy rate increased from 46% to 88%, the retention function rate increased from 10% to 76%, and the 5-year survival rate increased from 40% to 50%. The domestic surgical robot system developed and developed breakthrough card neck technology.
Lin Tianxin said that the idea of system establishment is to achieve early patients, to achieve small lesions through qualitative positioning to improve the early diagnosis rate, in addition, in the stage of staging treatment, through various technologies including artificial intelligence technology, to achieve accurate staging, so as to achieve the resection as clean as possible, should not be cut as far as possible to retain, the third to achieve the use of robotic instruments and minimally invasive surgery, after the implementation of radical resection of patients, both to save life and preserve the patient's sexual function and urinary control function. For patients with advanced inoperability, better treatments are found through basic research into bladder cancer.
Based on the above ideas, the team took the lead in developing non-invasive urine diagnostic technology, the existing urine diagnostic methods not only have the problem of misdiagnosis, high rate of missed diagnosis, and the sensitivity is not high, so it is solved by developing a variety of urine markers.
"After five years of research and development, urine DNA methylation technology can increase the diagnostic sensitivity of bladder cancer from the original 30-40% to 85-90%." Lin Tianxin said.
In addition, this technology fills the gap in early diagnosis of bladder cancer technology and is better than existing technologies at home and abroad. Among them, urine DNA methylation technology significantly improved sensitivity compared with cytology, and the sensitivity of early tumors increased from 32% to 79%. Diagnostic performance is better than similar products listed in Europe. Non-invasive urine diagnosis technology has been included in the 2019 and 2021 editions of the "China Bladder Cancer Diagnosis and Treatment Guidelines", and has been applied in more than 100 top three hospitals across the country, and has obtained FDA breakthrough medical device certification and EU CE certification.
In terms of accurate localization of tumors, according to Lin Tianxin, the original standard used invasive cystoscopes, the project team began to use a chemotherapy drug as a fluorescent agent more than 10 years ago to improve the diagnosis rate of small lesions, in recent years developed an AI-assisted diagnosis system, which can implement tracers, reduce missed diagnoses, and increase the diagnosis rate of tiny lesions to 84%.
In terms of preoperative precision staging, Lin Tianxin's team established a multi-omics diagnosis system for lymphatic metastases and clarified the scope of surgery. According to reports, the main metastasis method of bladder cancer is lymphatic metastasis, how to improve the accuracy of lymphatic micromethasta diagnosis, in the past, through traditional imaging, through the experience of doctors for naked eye judgment, through the establishment of imaging omics (CT / MR) model, the accuracy rate from 46% to 75%, after the establishment of a multi-omics diagnostic model, the accuracy rate increased from 75% to 88%. This range of techniques provides a new standard for the individualized diagnosis and treatment of pelvic lymphatic transfers.
At the same time, Lin Tianxin's team established the first minimally invasive function preservation system for bladder cancer in China, changing the surgical mode of bladder cancer. The original open surgical incision is large and can also greatly damage the patient's sexual function. The team was the first in the world to use laparoscopy for radical resection of bladder cancer, and only 5 small incisions were needed to remove the tumor. Nowadays, the robot surgical method has been further adopted, which has greatly improved the size of the incision and the guarantee of sexual function than the previous open surgery and laparoscopic surgery, and can achieve accurate resection and accurate reconstruction, and the retention rate of sexual function has reached 76%. The minimally invasive series of surgical tumors has a good effect on radical treatment, and has become the mainstream surgical method of bladder cancer in mainland China, and has also been included in the "Guidelines for the Diagnosis and Treatment of Bladder Cancer in China".
Lin Tianxin said in particular that Shenzhen Jingfeng Medical has developed a domestic surgical robot system, and has completed clinical research, compared with similar foreign products, in the degree of freedom, image delay and other indicators to achieve transcendence, and in the image resolution, stereo vision and other indicators at a considerable level.
For patients with advanced bladder cancer who cannot undergo resection surgery, the system further elucidates the lymphatic metastasis mechanism and discovers new therapeutic targets. A novel targeted therapy is provided to block bladder cancer metastasis, and a new strategy for targeted lymphatic metastasis is proposed.
In this regard, Lin Tianxin said that the research group found through more than 10 years of research that VEGF-C (vascular endothelial growth factor) and lymphatic metastasis, especially the generation of lymphatic vessels, so the use of VGFC monoclonal antibody technology to block, can reduce 60-70% of lymphatic metastasis, this research has now entered the clinical research stage. In addition, it was also found that in addition to VEGF-C, some other cytokines can also promote lymphatic metastasis by inducing the formation of lymphatic vessels, so the corresponding blocking technology can be used to achieve more than 80% of lymphatic metastases.
On the basis of a series of research results, Sun Yat-sen Memorial Hospital of Sun Yat-sen University established the China Bladder Cancer Alliance and the South China Urology Training Center, known as the Huangpu Military Academy of Minimally Invasive Urology in China, and has trained more than 20,000 backbone doctors from all over the country. In addition, the Guangdong Provincial Urological System Clinical Medical Research Center has also been established, which has improved the level of accurate and minimally invasive diagnosis and treatment in the province.
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Source | Yangcheng Evening News Yangcheng Pie
Editor-in-charge | Zeng Xiao
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