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Lozano F, Raventós CX, Carrion A, Dinarés C, Hernández J, Trilla E, Morote J. Xpert Bladder Cancer Monitor for the Early Detection of Non-Muscle Invasive Bladder Cancer Recurrences: Could Cystoscopy Be Substituted? Cancers (Basel) 2023; 15:3683. [PMID: 37509344 PMCID: PMC10378094 DOI: 10.3390/cancers15143683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/28/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
XBM was prospectively assessed in spontaneous urine collected just before flexible cystoscopy and washing cytology carried out within the first 2 years follow-up of 337 patients with NMIBC. Recurrences were pathologically confirmed in 49 patients (14.5%), 22 of them being high-risk (6.5%). The XBM sensitivity for detecting any type of recurrence was 69.4% and 63.6% in the cases of high-risk NMIBC. Negative predictive value (NPV) for XBM was 93% for all recurrences and 96.2% for high-risk recurrences. XBM could have avoided 213 invasive controls but missed the detection of 15 recurrences (30.6%)-8 of them of high-risk (36.4%). XBM false positive elevations were detected in 90 patients (26.7%), whereas 10 patients with the invasive method had a false positive result (3%), p <0.001. However, early detection of recurrences during the first year's follow-up after an XBM false positive result was observed in 18 patients (20%). On the other hand, 19 recurrences were detected during this period among the rest of the patients (7.7%)-p = 0.003, and odds ratio (OR) 3.0 (95% CI 1.5-6.0). Regarding one-year follow-up recurrences, 10% were high-risk recurrences in the XBM false positive group and 3.2% in the rest of the patients-p = 0.021, and OR 3.3 (95% CI 1.2-8.9). Additionally, 11.3% of the patients without false positive results developed a recurrence, p = 0.897, for any recurrence, being 10% and 5.2%, respectively, and high-risk and low-risk recurrences, p = 0.506. After searching for the best XBM cutoff for detecting the 38 high-risk initial recurrences and the early high-risk recurrences after a one-year follow-up, a linear discriminant analysis (LDA) of 0.13 could have avoided 11.3% of cystoscopies and bladder wash cytologies, as this cutoff missed only 1 high-risk recurrence (2.6%). More extensive and well-designed studies will confirm if XBM can improve the surveillance of NMIBC.
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Affiliation(s)
- Fernando Lozano
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain
| | - Carles X Raventós
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain
| | - Albert Carrion
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain
| | - Carme Dinarés
- Pathology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
| | - Javier Hernández
- Pathology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain
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Hekman MCH, Wijn SRW, Lotan Y, Govers TM, Witjes JA. Bladder EpiCheck urine test in the follow-up of NMIBC: a cost analysis. World J Urol 2023; 41:471-476. [PMID: 36534153 DOI: 10.1007/s00345-022-04252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE In the Netherlands yearly more than 5000 patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). With a specificity of 88.0% and a negative predictive value (NPV) for high grade NMIBC of 99.3%, the Bladder EpiCheck (BE) urine test may be used in NMIBC to reduce the burden of follow-up cystoscopies. METHODS In this study a cost analysis of the BE follow-up strategy in the Dutch healthcare system was performed. In half of the follow-up appointments, BE was used as a rule-in for cystoscopy. In addition, the possible delay in recurrence detection was estimated. A cost calculation tool was developed using Microsoft Excel. RESULTS The BE strategy results in an estimated cost reduction of 8%, 4% and 9% in low, intermediate and high risk patients, respectively. In the Netherlands this may result in a cost reduction of approximately 1.6 million euro per year. The estimated delay in the detection of recurrent disease would be 3.9, 1.7 and 1.3 months in low, intermediate and high risk NMIBC patients respectively. CONCLUSION To conclude, the BE can be used to reduce the costs of NMIBC follow-up, with a small delay in diagnosis of recurrent disease.
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Affiliation(s)
| | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tim Martin Govers
- Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
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Malinaric R, Mantica G, Lo Monaco L, Mariano F, Leonardi R, Simonato A, Van der Merwe A, Terrone C. The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159648. [PMID: 35955004 PMCID: PMC9368399 DOI: 10.3390/ijerph19159648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 05/20/2023]
Abstract
The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
| | - Lorenzo Lo Monaco
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Federico Mariano
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Rosario Leonardi
- Department of Urology, Casa di Cura Musumeci GECAS, 95030 Gravina di Catania, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town 7600, South Africa
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
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Eilender BM, Katims AB, Pfail JL, Sfakianos J. Evolving Treatment in Non-muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Russell B, Kotecha P, Thurairaja R, Nair R, Malde S, Kumar P, Khan MS. Endoscopic surveillance for bladder cancer: a systematic review of contemporary worldwide practices. Transl Androl Urol 2021; 10:2750-2761. [PMID: 34295760 PMCID: PMC8261410 DOI: 10.21037/tau-20-1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/25/2021] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this systematic review was to identify the current endoscopic surveillance strategies in use across the world and to determine whether these were sufficient or if any recommendations for changes in the guidelines could be made. This review focused on the cystoscopic follow-up of non-muscle invasive bladder cancer (NMIBC) patients and muscle invasive bladder cancer (MIBC) patients who had undergone bladder sparing treatments. Methods A literature search was carried out on Medline and Embase using OVID gateway according to a pre-defined protocol. Systematic screening of the identified studies was carried out by two authors. Quality assessment was performed using the Joanna Briggs critical appraisal tools. Data was extracted on various aspects including the follow-up regime utilised, patients included, outcomes investigated and a summary of the results. The studies were compared in a narrative nature. Results A total of 2,604 studies were identified from the search strategy, of which 14 were deemed suitable for inclusion following the screening process. The studies identified were from nine countries and were mainly observational or qualitative. There was a huge variation in the follow-up regimes utilised within the studies with no clear consensus as to which regime was the most suitable. However, all studies utilised an initial cystoscopy at three months post-TURBT. No studies were identified which investigated the endoscopic follow-up strategies for MIBC patients who opted for bladder conservation with chemoradiation. Conclusions There is no universally accepted protocol for endoscopic follow-up of patients with NMIBC bladder cancer. Guidance on cystoscopic monitoring of bladder in patients who have undergone chemoradiation for MIBC is also lacking.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Pinky Kotecha
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Ramesh Thurairaja
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Rajesh Nair
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Pardeep Kumar
- Department of Urology, Royal Marsden NHS Foundation Trust, London, UK
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Reis LO. Non-muscle invasive bladder cancer cystoscopic surveillance: from overuse to underuse and non-adherence impact. Transl Androl Urol 2020; 8:S472-S473. [PMID: 32042620 DOI: 10.21037/tau.2019.10.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Leonardo O Reis
- UroScience and Department of Urologic Oncology, Pontifical Catholic University of Campinas (PUC-Campinas), São Paulo, Brazil
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[Mass spectrometry-applications in pathology]. DER PATHOLOGE 2019; 40:277-281. [PMID: 31713660 DOI: 10.1007/s00292-019-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently, more complex and extensive diagnostic pathology work-up of sometimes only limited sample material is necessary to ensure optimal patient treatment. This often includes genomic analyses. However, dynamic changes within an organism or tumor can be better reflected at the protein level. Therefore, proteomic technologies would seem to be the solution. OBJECTIVES To evaluate the application of different proteomic techniques to analyze body fluids and tissue samples with regards to implementation in diagnostics. MATERIALS AND METHODS All studies utilized mass spectrometry-based methods in order to achieve differentiation of a number of different patient groups in various diseases. RESULTS Whereas classical proteomic methods are particularly suitable for analyzing serum samples in order to diagnose bladder cancer or chronic hepatitis C, tissue analyses would require prior tissue lyses, thus erasing possible information to be obtained from histology. Imaging mass spectrometry offers a solution as it allows for the analysis of an intact tissue section. Possible applications and the added benefit of this method could be shown using various examples of tumors (prostate cancer, Hodgkin's lymphoma, cervical cancer, and different types of adenocarcinomas). CONCLUSIONS Mass spectrometry-based technologies allow diagnostic confirmation with high sensitivity and specificity. In comparison to routine diagnostic approaches, results can be achieved faster, using less sample material, and with comparable accuracy.
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