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Background: Both genetic mutations and epigenetic alterations of various factors play important roles in carcinogenesis of the urinary bladder.This study aimed to investigate the chromosomal aberrations of exfoliated bladder cells in the urine and blood oxidative stress in patients with bladder transitional cell carcinoma (BTCC).Methods: Forty healthy controls and 246 BTCC patients were recruited, and FISH was employed to detect the abnormal CSP3, CSP7, CSP17 and GLPp16 of exfoliated bladder cells in the urine.In addition, the blood oxidative stress was also evaluated by measuring serum TOS, TAS and OSI.The association of abnormal CSP3,CSP7, CSP17 and GLPp16 with blood oxidative stress was further evaluated.Results: Significant differences were observed in the abnormal CSP3 (50.4% vs 10.0%), CSP7 (53.3% vs 12.5%), CSP17 (44.7% vs 7.5%), GLPp16 (60.2% vs 17.5%) and FISH positive rate (54.5% vs 0.0%) between BTCC patients and controls (P <0.001).Serum TOS (18.56 ±3.72 vs 14.64 ± 1.29μmol H2O2 Eq./L), TAS (1.44 ±0.23 vs 1.65 ±0.17mmolTrolox Eq./L) and OSI (1.35 ±0.43 vs O.89 ±0.11) were also significantly different between two groups (P < 0.001).The clinical stage of BTCC was not associated with abnormal CSP3, CSP7, CSP17 and GLPp16, FISH positive rate and oxidative stress (P > 0.05).Gamma rank correlation analysis showed relationships of pathological grade of BTCC with abnormal CSP3, CSP7 and CSP17 as well as FISH positive rate (r =0.515, 0.639, 0.587 and 0.413, P < 0.001).In addition, the clinical stage of BTCC was also related to serum TOS, TAS and OSI (Spearman correlation;r =0.671,-0.326 and 0.660, P < 0.001) Evaluation of association between chromosomal aberrations and oxidative stress showed abnormal CSP3, CSP7 and CSP17 were positively related to serum TOS and OSI (P < 0.001), abnormal CSP7 and CSP17 were negatively associated with serum TAS (P <0.001), but abnormal GLPp16 had no relationship with serum TOS, TAS and OSI (P > 0.05).Conclusions: The chromosomal aberrations of exfoliated bladder cells in the urine are closely related to blood oxidative stress in BTCC patients, and the occurrence and development may be as a result of interaction between them.