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Wang B, He C, Li Y, Jiang Y, Li X, Li Z, Peng C, Li H, Peng X, Zheng X, Xu F. Aminopeptidase N-Triggered Electron Rearrangement of Fluorescein for Covalent Fluorescent Labeling and Image-Guided Orthotopic Bladder Cancer Resection. Anal Chem 2025; 97:11927-11936. [PMID: 40448611 DOI: 10.1021/acs.analchem.5c02393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2025]
Abstract
Bladder cancer is the most common type of malignant tumor in the urinary system, which occurs in the bladder mucosa. Due to the lack of precise diagnostic tools, bladder cancer has a high recurrence rate. Fluorescence cystoscopy is recognized as a promising tool for improving the detection rate of bladder cancer, but its clinical application is hindered due to the scarcity of fluorescent agents. To address this issue, an aminopeptidase N (APN)-activated fluorescent agent with specific recognition and labeling abilities for bladder cancer has been developed. The fluorescent agent, namely, Flu-FAPN, exhibited high sensitivity and specificity toward APN under physiological conditions. The fluorescent intensity increased more than 37-fold after reacting with APN, and the detection limit is 0.10 ng/mL for APN. In addition, the hydrolysis of alanine catalyzed by APN could initiate the intramolecular electron rearrangement process, which subsequently contributed to the formation of protein-fluorescein adduct and thereby achieved covalent labeling of bladder cancer cells. Cell experiments conducted in cancer and normal cells demonstrate that Flu-FAPN has low cytotoxicity and high specificity for bladder cancer cells with an obvious fluorescence signal, which could be retained over 80% even in fixed cells. Finally, Flu-FAPN was successfully applied for the fluorescence-image-guided resection of tumor tissues in mice with orthotopic bladder cancer. We hope this covalent labeling-based agent can provide a promising tool for surgery navigation and accelerate the clinical application of fluorescence cystoscopy, thereby improving the cure rate of bladder cancer.
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Affiliation(s)
- Bing Wang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Chaoxiang He
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Yueqing Li
- School of Pharmaceutical Science and Technology, Dalian University of Technology, Dalian 116024, PR China
| | - Yihan Jiang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Xiongjie Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Zonglong Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Changzhen Peng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Haidong Li
- State Key Laboratory of Fine Chemicals, Frontiers Science Center for Smart Materials Oriented Chemical Engineering, Dalian University of Technology, Dalian 116024, PR China
| | - Xiaojun Peng
- State Key Laboratory of Fine Chemicals, Frontiers Science Center for Smart Materials Oriented Chemical Engineering, Dalian University of Technology, Dalian 116024, PR China
| | - Xiaoqun Zheng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
- The Key Laboratory of Laboratory Medicine, Ministry of Education, Wenzhou 325035, PR China
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325035, PR China
| | - Feng Xu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, PR China
- The Key Laboratory of Laboratory Medicine, Ministry of Education, Wenzhou 325035, PR China
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2
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Tomiyama E, Fujita K, Matsuzaki K, Narumi R, Matsushita M, Hayashi Y, Hashimoto M, Kato T, Hatano K, Kawashima A, Minami T, Takao T, Takada S, Uemura H, Adachi J, Tomonaga T, Nonomura N. EIF2S1 in Urinary Extracellular Vesicles as a Novel Diagnostic Marker for Bladder Cancer. Cancer Med 2025; 14:e70964. [PMID: 40365898 PMCID: PMC12076193 DOI: 10.1002/cam4.70964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 04/17/2025] [Accepted: 04/30/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Urinary extracellular vesicles (uEVs), directly secreted from bladder cancer (BCa) cells, harbor potential for biomarker discovery. METHODS We performed proteomic analysis to explore and validate uEV-based diagnostic markers for BCa, with a focus on cytoplasmic EV proteins. Among the 1960 proteins identified by shotgun proteomics (tandem mass tag-labeled liquid chromatography-tandem mass spectrometry [LC-MS/MS]) of uEVs from seven patients with BCa and four healthy individuals, 17 cytoplasmic EV proteins were significantly elevated in the patients' urine (fold change > 1.5; p < 0.05). These 17 proteins were subsequently validated using targeted proteomics (selected reaction monitoring/multiple reaction monitoring) using urine samples from 49 and 48 patients with and without BCa, respectively, including those with non-BCa hematuria. RESULTS Ten measurable EV proteins remained significantly elevated in the urine of patients with BCa, with EV-EIF2S1 demonstrating the best diagnostic performance (area under the receiver operating characteristic [ROC] curve [AUC] [ROCAUC]: 0.83). Additionally, EV-EIF2S1 distinguished patients with BCa from those without BCa and hematuria in a suitable manner (ROCAUC: 0.92). Functional analysis of EIF2S1 in the BCa cell lines (T24 and 5637) showed that EIF2S1 knockdown markedly inhibited cell proliferation and induced cell cycle arrest and apoptosis, suggesting its essentiality for BCa cell growth and survival. CONCLUSIONS This study identified EV-EIF2S1 as a novel, uEV-based BCa diagnostic marker and demonstrated its functional significance in BCa cell growth and survival.
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Affiliation(s)
- Eisuke Tomiyama
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Kazutoshi Fujita
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Kyosuke Matsuzaki
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Ryohei Narumi
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Makoto Matsushita
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yujiro Hayashi
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Mamoru Hashimoto
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Taigo Kato
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Koji Hatano
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Atsunari Kawashima
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Takafumi Minami
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Tetsuya Takao
- Department of UrologyOsaka General Medical CenterOsakaOsakaJapan
| | - Shingo Takada
- Department of UrologyOsaka Police HospitalOsakaOsakaJapan
| | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Jun Adachi
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Takeshi Tomonaga
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
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3
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Cao M, Yang G, Zhao T, Zhang L, Wang D, Cao Y, Chen H, Jin D, Zhang R, Hao Y, Huang L, Liu W, Zhang Y, Xue N, Xue W. Development and Validation of the UriMee Model: A Methylation-based Diagnostic Tool for Early Diagnosis of Urothelial Carcinoma. Eur Urol Oncol 2025:S2588-9311(25)00079-3. [PMID: 40240254 DOI: 10.1016/j.euo.2025.03.004] [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: 09/05/2024] [Revised: 02/24/2025] [Accepted: 03/11/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND AND OBJECTIVE Urothelial carcinoma (UC) is a common malignancy that imposes a significant health care burden. Current diagnostic methods are limited by their invasiveness and low sensitivity, particularly for detecting low-grade tumors. Noninvasive, accurate, and reliable diagnostic tests for an early diagnosis of UC are urgently needed. METHODS UC-specific DNA methylation biomarkers were identified by combining public datasets from The Cancer Genome Atlas and Gene Expression Omnibus with a cohort from Renji Hospital (n = 50). Using the Least Absolute Shrinkage and Selection Operator regression, we developed a diagnostic model, termed the UriMee model, by selecting key biomarkers from a model cohort (n = 322) and subsequently validating it in an independent cohort (n = 131). The diagnostic performance of the assay was evaluated and compared with that of urine cytology. KEY FINDINGS AND LIMITATIONS At 30% threshold probability, the UriMee model demonstrated high sensitivity (92%) and specificity (92%) in distinguishing UC cases, with particularly strong performance in early-stage tumors (83% sensitivity for Ta, 93% for T1, and 100% for Tis). It significantly outperformed urine cytology, offering greater sensitivity (90% vs 25%, p < 0.001) while maintaining comparable specificity. Additionally, the model was highly effective in identifying upper tract urothelial carcinoma (UTUC), achieving sensitivity of 96%. The study's limitations include the necessity for larger multicenter studies and long-term follow-up to validate the findings and assess the test's effectiveness across diverse populations, as well as its utility in monitoring disease progression and recurrence. CONCLUSIONS The UriMee test demonstrated high sensitivity and specificity, particularly in detecting early-stage tumors and UTUC, significantly outperforming traditional methods.
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Affiliation(s)
- Ming Cao
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Guoliang Yang
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Tingting Zhao
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China; Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Clinical and Translation Research Center, Shanghai First Maternity and Infant Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Lianhua Zhang
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Dandan Wang
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Yang Cao
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haige Chen
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Di Jin
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ruiyun Zhang
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuping Hao
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Longfei Huang
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Wei Liu
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Yang Zhang
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Na Xue
- GloriousMed Clinical Laboratory Co. Ltd., Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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4
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Zhou Y, Wang R, Zeng M, Liu S. Circulating tumor DNA: a revolutionary approach for early detection and personalized treatment of bladder cancer. Front Pharmacol 2025; 16:1551219. [PMID: 40191434 PMCID: PMC11968738 DOI: 10.3389/fphar.2025.1551219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 02/25/2025] [Indexed: 04/09/2025] Open
Abstract
Bladder cancer is a malignant tumor with a high global incidence and recurrence rate. Traditional diagnostic methods, such as cystoscopy and urine cytology, have limitations in sensitivity and specificity, particularly in detecting low-grade bladder cancer. Circulating tumor DNA (ctDNA) offers a non-invasive alternative, reflecting tumor genetic characteristics through blood samples. It demonstrates high sensitivity and repeatability, making it a promising tool for early detection, recurrence monitoring, and treatment evaluation. Clinical studies have shown that ctDNA not only detects tumor burden but also captures dynamic tumor mutations, aiding in personalized treatment strategies. Despite its potential, clinical implementation of ctDNA faces challenges, including optimization of detection techniques, standardization, and the cost of testing. This paper explores the role of ctDNA in advancing bladder cancer diagnosis and treatment, with a focus on refining its clinical application and guiding future research toward improved patient outcomes.
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Affiliation(s)
- Yan Zhou
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Rongzhong Wang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtang Zeng
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Sijia Liu
- West China Hospital, Sichuan University, Chengdu, China
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5
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Ben Muvhar R, Paluch R, Mekayten M. Recent Advances and Emerging Innovations in Transurethral Resection of Bladder Tumor (TURBT) for Non-Muscle Invasive Bladder Cancer: A Comprehensive Review of Current Literature. Res Rep Urol 2025; 17:69-85. [PMID: 40104687 PMCID: PMC11917164 DOI: 10.2147/rru.s386026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 02/05/2025] [Indexed: 03/20/2025] Open
Abstract
Bladder cancer management, particularly non-muscle-invasive bladder cancer (NMIBC), has evolved significantly due to advancements in imaging techniques and surgical methodologies. Enhanced tumor visualization methods, including Photodynamic Diagnosis (PDD) and Narrow-Band Imaging (NBI), offer improved detection rates for both papillary tumors and carcinoma in situ (CIS), compared to traditional white-light cystoscopy (WLC). Recent studies suggest that these technologies enhance diagnostic accuracy, reduce recurrence rates, and improve oncological outcomes. Additionally, transurethral resection of bladder tumors (TURBT), performed with advanced imaging, has demonstrated better resection quality, particularly in terms of detrusor muscle presence. Despite these innovations, challenges remain in the long-term impact on recurrence-free and progression-free survival. Artificial intelligence (AI) integration into cystoscopic imaging further promises enhanced diagnostic precision and cost-effective bladder cancer management. As personalized treatment paradigms emerge, predictive biomarkers, including genomic and pathological markers, may help stratify patients for aggressive treatment, sparing those at lower risk from unnecessary interventions. Future research should focus on validating these AI models and combining them with enhanced imaging modalities to refine treatment protocols further. These advancements collectively represent a significant leap toward precision medicine in bladder cancer care.
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Affiliation(s)
- Rei Ben Muvhar
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reem Paluch
- Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Matan Mekayten
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Urology, Sanz Medical Center, Laniado Hospital, Netanya, Israel
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6
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Lee S, Sfanos K, Singla N. The role of the urinary microbiome in genitourinary cancers. Nat Rev Urol 2025:10.1038/s41585-025-01011-z. [PMID: 40082677 DOI: 10.1038/s41585-025-01011-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2025] [Indexed: 03/16/2025]
Abstract
Genitourinary cancers account for 20% of cancer instances globally and pose a substantial burden. The microbiome, defined as the ecosystem of organisms that reside within and on the human body, seems to be closely related to multiple cancers. Research on the gut microbiome has yielded substantial insights into the interactions of this entity with the immune system and cancer therapeutic efficacy, whereas the urinary microbiome has been relatively less well-studied. Advances in next-generation sequencing technologies led to new discoveries in the urinary microbiome, which might aid in early detection, risk stratification and personalized treatment strategies in genitourinary cancers. Mechanistic investigations have also suggested a role for the urinary microbiome in modulating the tumour microenvironment and host immune response. For example, distinct urinary microbial signatures have been linked to bladder cancer occurrence and recurrence risk, with specific taxa associated with cytokine production and inflammation. Urinary microbiome signatures have also been explored as potential biomarkers for non-invasive cancer detection. However, challenges remain in standardizing methodologies, validating findings across studies, and establishing causative mechanisms. As investigations into the urinary microbiome continue to evolve, so does the potential for developing microbiome-modulating therapies and enhancing diagnostic capabilities to improve outcomes in patients with genitourinary cancers.
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Affiliation(s)
- Seoho Lee
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Sfanos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
- Department of Urology, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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7
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Ecke TH, Meisl CJ, Schlomm T, Rabien A, Labonté F, Rong D, Hofbauer S, Friedersdorff F, Sommerfeldt L, Gagel N, Gössl A, Barski D, Otto T, Grunewald CM, Niegisch G, Hennig MJP, Kramer MW, Koch S, Roggisch J, Weiß S, Waldner M, Graff J, Veltrup E, Linden F, Hake R, Eidt S, Wirtz RM, Klatte T. Performance of Urinary Markers in Patients With Suspicious Cystoscopy During Follow-up of Recurrent Non-muscle Invasive Bladder Cancer: BTA Stat, NMP22 BladderChek, UBC Rapid Test, CancerCheck UBC Rapid VISUAL, and Uromonitor in Comparison to Cytology. Urology 2025; 197:119-125. [PMID: 39626834 DOI: 10.1016/j.urology.2024.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 10/29/2024] [Accepted: 11/26/2024] [Indexed: 12/21/2024]
Abstract
OBJECTIVE To compare all available rapid tests on a large cohort of recurrent bladder cancer during follow-up in this multicentre-study is the first study. BTA stat, NMP22 BladderChek, UBC Rapid Test CancerCheck UBC rapid VISUAL, and uromonitor are urinary-based rapid tests for bladder cancer detection. METHODS In total, 187 urine samples were analyzed from patients with suspected recurrent non-muscle invasive urothelial bladder cancer on cystoscopy during follow-up in a real-world assessment. All suspicious lesions were resected with 110 samples showing recurrent urothelial cancer. Urine samples were analyzed by the BTA stat, NMP22 BladderChek, UBC Rapid Test, CancerCheck UBC rapid VISUAL, uromonitor, and cytology. Sensitivities and specificities were calculated by contingency analyses. RESULTS All investigated urinary markers could detect a higher percentage of pathological results in urine of bladder cancer patients compared to urine of tumor free patients. The calculated diagnostic sensitivities for BTA stat, NMP22 BladderChek, UBC Rapid Test, CancerCheck UBC rapid VISUAL, uromonitor, and cytology were 60.0%, 10.0%, 58.0%, 32.0%, 54.5%, and 41.5% for non-muscle invasive low-grade, and 64.0%, 40.0%, 77.8%, 50.0%, 56.0%, and 65.5% for non-muscle invasive high-grade bladder cancer. The specificity was 51.3%, 94.8%, 66.2%, 89.5%, 94.9%, and 66.2%, respectively. CONCLUSION During follow-up sensitivities and specificities of most urinary markers are higher compared to cytology for the detection of recurrent bladder cancer. BTA stat, UBC Rapid Test, and uromonitor appear useful in this setting.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany; Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christina J Meisl
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora Labonté
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Lilli Sommerfeldt
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nella Gagel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Andreas Gössl
- Rheinland Klinikum Neuss, Department of Urology, Neuss, Germany
| | - Dimitri Barski
- Rheinland Klinikum Neuss, Department of Urology, Neuss, Germany
| | - Thomas Otto
- Rheinland Klinikum Neuss, Department of Urology, Neuss, Germany; University Hospital Essen, Essen, Germany
| | - Camilla M Grunewald
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Mario W Kramer
- Department of Urology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Stefan Koch
- Institute of Pathology, Helios Hospital, Bad Saarow, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Jenny Roggisch
- Institute of Pathology, Helios Hospital, Bad Saarow, Germany
| | - Sarah Weiß
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Johannes Graff
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | - Roland Hake
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Tobias Klatte
- Department of Urology, Helios Hospital, Bad Saarow, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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8
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Jeong IG, Yun SC, Ha HK, Kang SG, Lee S, Park S, Sung HH, Kim SI, Hwang EC, Moon KC, Kwak C. Urinary DNA Methylation Test for Bladder Cancer Diagnosis. JAMA Oncol 2025; 11:293-299. [PMID: 39883469 PMCID: PMC11783243 DOI: 10.1001/jamaoncol.2024.6160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 10/29/2024] [Indexed: 01/31/2025]
Abstract
Importance An accurate noninvasive biomarker test is needed for the early diagnosis of bladder cancer. Objective To evaluate the performance of a urinary DNA methylation test (PENK methylation) and compare its diagnostic accuracy with that of the nuclear matrix protein 22 (NMP22) test or urine cytology test. Design, Setting, and Participants In this prospective multicenter study at 10 sites in the Republic of Korea, individuals 40 years and older with hematuria undergoing cystoscopy within 3 months between March 11, 2022, and May 30, 2024, participated. The study participants were evaluated for bladder cancer using a urinary DNA methylation test. Exposure Urinary DNA methylation test, NMP22 test, and urine cytology test. Main Outcomes and Measures The primary outcomes were the sensitivity and specificity of the urinary DNA methylation test for high-grade or invasive bladder cancer. Secondary objectives included the accuracy of the test for overall bladder cancer (all stages and grades) and the comparison of sensitivities and specificities for bladder cancer between the urinary DNA methylation test and the NMP22 test or urine cytology test. Results Among the 1099 participants, 614 (55.9%) were male; participants had a mean (SD) age of 65 (10) years. Of the 1099 participants, 219 and 176 participants had bladder cancer and high-grade or invasive bladder cancer, respectively. The urinary DNA methylation test had sensitivity and specificity for high-grade or invasive bladder cancer of 89.2% (95% CI, 84.6%-93.8%) and 87.8% (95% CI, 85.6%-89.9%), respectively. Sensitivity and specificity for overall bladder cancer were 78.1% (95% CI, 72.6%-83.6%) and 88.8% (95% CI, 86.7%-90.8%), respectively. The positive predictive value for high-grade or invasive bladder cancer was 61.3% (95% CI, 55.4%-67.3%), and the negative predictive value was 97.6% (95% CI, 96.6%-98.7%). In comparison with the NMP22 test or urine cytology test, the urinary DNA methylation test showed significantly superior sensitivity for high-grade or invasive bladder cancer and overall bladder cancer. Conclusions and Relevance In this prospective multicenter study of individuals with hematuria, the urinary DNA methylation test showed 89% sensitivity for detecting high-grade or invasive bladder cancer, outperforming the NMP22 test or urine cytology test with high specificity. While this test had an excellent negative predictive value, its positive predictive value was suboptimal.
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Affiliation(s)
- In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung Cheol Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
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9
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Martinez LM, Ribeiro LCSL, Guidi RG, de Moraes CMT, Lyra CR, Liebl B, Guimarães VHA, de Lima RD, de Almeida LS, Suartz CV, Nahas WC, Ribeiro-Filho LA. Cell-free Tumor DNA: a Promising Technology for Diagnosis, Surveillance and Therapeutic Decision in Urothelial Carcinoma of the Bladder. Curr Oncol Rep 2025; 27:225-235. [PMID: 39937352 DOI: 10.1007/s11912-025-01648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2025] [Indexed: 02/13/2025]
Abstract
PURPOSE OF REVIEW This narrative review aims to discuss the latest evidence for cell-free tumor DNA (ctDNA) use in bladder cancer, future perspectives and challenges in implementing this technology in clinical practice. RECENT FINDINGS Recent papers describe promising findings regarding ctDNA analysis in blood samples and in urine of bladder cancer patients. This biomarker can be used as a diagnostic tool, in prognostic evaluation and as additional data for treatment indication and surveillance.
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Affiliation(s)
- Lucas Motta Martinez
- Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Rodrigo Gilles Guidi
- Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | | | - Bruno Liebl
- Federal University of Paraná, Curitiba, Brazil
| | | | - Richard Dobrucki de Lima
- Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Lucas Schenk de Almeida
- Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Caio Vinicius Suartz
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - William Carlos Nahas
- Division of Urology, Institute of Cancer of São Paulo, University of São Paulo, São Paulo, Brazil
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10
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Wan X, Wang D, Zhang X, Xu M, Huang Y, Qin W, Chen S. Unleashing the power of urine‑based biomarkers in diagnosis, prognosis and monitoring of bladder cancer (Review). Int J Oncol 2025; 66:18. [PMID: 39917986 PMCID: PMC11837902 DOI: 10.3892/ijo.2025.5724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/13/2025] [Indexed: 02/21/2025] Open
Abstract
Bladder cancer (BCa) is a prevalent malignant neoplasm of the urinary tract with high incidence rate, frequent recurrence and rapid disease progression. Conventional approaches for diagnosing, prognosticating and monitoring BCa often rely on invasive procedures such as cystoscopy and tissue biopsy, which are associated with high costs and low patient compliance for follow‑up. Liquid biopsies have advantages, such as being non‑invasive, real‑time, and reproducible, in obtaining diverse biomarkers derived from cellular, molecular, proteomic and genetic signatures in urine or plasma samples. Although plasma‑based biomarkers have been clinically validated, urine provides greater specificity for directly assessing biological materials from urological sources. The present review summarizes advancements and current limitations in urinary protein, genetic and epigenetic biomarkers for disease progression and treatment response of BC, compares performance and application scenarios of urine and blood biomarkers and explores how urinary biomarkers may serve as an alternative or complementary tool to traditional diagnostic methods. The integration of urine‑based or plasma‑based biomarkers into existing diagnostic workflows offers promising avenues for improving accuracy and efficiency of diagnosis in the management of BCa. Notably, the emergence of synthetic biomarkers and urine metabolites, combined with artificial intelligence or bioinformatic technologies, has promise in the screening of potential targets. Continued research and validation efforts are needed to translate these findings into routine clinical practice, ultimately improving patient outcomes and decreasing the burden of BCa.
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Affiliation(s)
- Xuebin Wan
- Department of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P.R. China
- Department of Research and Development, HaploX Biotechnology, Co., Ltd., Shenzhen, Guangdong 518057, P.R. China
| | - Dan Wang
- Department of Molecular Microbiology and Genetics, Institute for Microbiology and Genetics, University of Goettingen, Göttingen D-37077, Germany
| | - Xiaoni Zhang
- Department of Research and Development, HaploX Biotechnology, Co., Ltd., Shenzhen, Guangdong 518057, P.R. China
| | - Mingyan Xu
- Department of Research and Development, HaploX Biotechnology, Co., Ltd., Shenzhen, Guangdong 518057, P.R. China
| | - Yuying Huang
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Wenjian Qin
- Department of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P.R. China
| | - Shifu Chen
- Department of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, P.R. China
- Department of Research and Development, HaploX Biotechnology, Co., Ltd., Shenzhen, Guangdong 518057, P.R. China
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11
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Wang WD, Yang XR, Li WH, Cheng JM, Wu JY, Cai JM, Chen H. Analysis the diagnostic performance of H4C6/SOX1-OT gene methylation in bladder cancer based on urine sample. Sci Rep 2025; 15:6961. [PMID: 40011626 PMCID: PMC11865265 DOI: 10.1038/s41598-025-91337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 02/19/2025] [Indexed: 02/28/2025] Open
Abstract
Bladder cancer (BCa) is the second most common urological malignancy, but the techniques used today to detect and monitor BCa are frequently invasive and/or have inadequate sensitivity and specificity. Therefore, it is imperative to create a noninvasive test that is both sensitive and accurate for diagnosing BCa. This research introduces and validates the diagnostic performance of H4C6/SOX1-OT gene methylation in the diagnosis of BCa based on urine samples by designing two parts of studies: the case-control study and the prospective validation study. In the case-control study, the methylation test of H4C6/SOX1-OT achieved a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 87.9%(95%CI, 79.4%-93.3%)/90.4%(95%CI, 80.7%-95.7%)/92.6%(95%CI, 84.8%-96.7%)/ 84.6%(95%CI, 74.3%-91.5%) (kappa value 77.6%). The sensitivities for low grade, high grade, Ta-T1, and T2-T4 were 85% (17/20), 88.6% (70/79), 85.4% (41/48) and 92.6% (25/27). Statistical analysis showed the diagnostic sensitivity of test was not affected by sex, age, tumor grade or tumor stage (P > 0.05). In the prospective validation study, the H4C6/SOX1-OT methylation test yielded an overall sensitivity/specificity/PPV/NPV of 84.8%(95%CI, 67.3%-94.3%)/90.0%(95%CI, 75.4%-96.7%)/87.5% (95%CI, 70.1%-95.9%)/84.6% (95%CI, 73.0%-95.4%) (kappa value 75.0%), indicating 38.4% of spared cystoscopy. These findings highlight the potential of the H4C6/SOX1-OT methylation in urine DNA as a promising molecular diagnostic tool for detecting BCa, especially for early-stage tumors, which may reduce the need for cystoscopy.
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Affiliation(s)
- Wan-Dang Wang
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, China
| | - Xu-Ran Yang
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
| | - Wen-Hua Li
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
| | - Jing-Mao Cheng
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, China
| | - Jing-Yi Wu
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
| | - Jin-Mei Cai
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China
| | - Hui Chen
- Department of Clinical Medicine Laboratory, Xiaolan People's Hospital of Zhongshan, No. 65, Jucheng Avenue, Xiaolan Town, Zhongshan, Guangdong, China.
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12
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Contieri R, Soloway MS, Gontero P, Herr H, Kassouf W, Mertens LS, Moschini M, O'Donnell M, Palou J, Psutka SP, Rouprêt M, Teoh JYC, Kamat AM. Deintensification of Treatment for Low-grade Bladder Tumors: A Collaborative Review by the International Bladder Cancer Group (IBCG). Eur Urol Oncol 2025; 8:179-189. [PMID: 39218742 DOI: 10.1016/j.euo.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Management of low-grade (LG) urothelium-confined (Ta stage) non-muscle-invasive bladder cancer (NMIBC) poses a distinct therapeutic challenge. Transurethral resection of bladder tumor (TURBT), the standard treatment, frequently has to be repeated because of high tumor recurrence rates. This places a considerable strain on both patients and health care infrastructure, underscoring the need for alternative management approaches. Herein, the IBCG (International Bladder Cancer Group), conducted a review to explore the efficacy and safety of deintensified treatment strategies for recurrent LG Ta NMIBC. METHODS We conducted a collaborative review of relevant literature in the PubMed/MEDLINE and Cochrane CENTRAL databases. Our focus was on high-quality evidence, including randomized controlled trials, systematic reviews, and meta-analyses. We also reviewed guidelines published by prominent urological associations. KEY FINDINGS AND LIMITATIONS Active surveillance, chemoablation, and office fulguration are valid treatment options for recurrent LG Ta NMIBC. These deintensified approaches offer several advantages over TURBT: lower complication rates, less morbidity, lower health care costs, and better quality of life for patients. Importantly, these benefits are achieved without compromising oncological safety. CONCLUSIONS AND CLINICAL IMPLICATIONS Our review demonstrates that less intensive treatment strategies for recurrent LG Ta NMIBC are both feasible and valuable. The IBCG recommends use of these approaches for carefully selected patients to help lower health care costs and enhance patients' quality of life. PATIENT SUMMARY We reviewed studies on less invasive management options for low-grade noninvasive bladder cancer, including active surveillance, chemical ablation, and heat treatment. Recent results confirm that these less intense treatment options can reduce the treatment burden and costs for patients and preserve their quality of life without negatively affecting cancer control outcomes.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mark S Soloway
- Division of Urology, Urologic Oncology Memorial Physician Group, Memorial Hospital, Hollywood, FL, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, Canada
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Michael O'Donnell
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Department of Urology, Sorbonne University, Pitie-Salpetriere Hospital, AP-HP, Paris, France
| | - Jeremy Y C Teoh
- SH Ho Urology Centre, Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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13
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Rabien A, Rong D, Rabenhorst S, Schlomm T, Labonté F, Hofbauer S, Forey N, Le Calvez-Kelm F, Ecke TH. Diagnostic performance of Uromonitor and TERTpm ddPCR urine tests for the non-invasive detection of bladder cancer. Sci Rep 2024; 14:30617. [PMID: 39715826 PMCID: PMC11666540 DOI: 10.1038/s41598-024-83976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/18/2024] [Indexed: 12/25/2024] Open
Abstract
Uromonitor and urinary telomerase reverse transcriptase promoter mutation droplet digital PCR (uTERTpm ddPCR) are non-invasive tests designed to detect bladder cancer in urine. We aimed to compare the diagnostic performance of uTERTpm ddPCR, Uromonitor and urine cytology in detecting bladder cancer. Urine samples were collected prospectively from patients diagnosed with primary (n = 74) and recurrent bladder cancer (n = 20) or benign urological conditions (n = 48) prior to surgical resection. The samples were tested for bladder cancer via uTERTpm ddPCR, Uromonitor and urine cytology. The sensitivity, specificity, and predictive values were calculated for each test, including confidence intervals. The results were stratified by low-grade non-muscle-invasive bladder cancer, high-grade non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. Compared with urine cytology (59.5%, p = 0.005) and Uromonitor (56.8%, p = 0.001), the uTERTpm ddPCR test had the highest sensitivity (79.7%) for the detection of primary bladder cancer. Specificity did not significantly differ. The uTERTpm ddPCR test exhibited superior diagnostic performance over urine cytology and Uromonitor, highlighting its potential for non-invasive primary bladder cancer diagnosis.
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Affiliation(s)
- Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Silke Rabenhorst
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nathalie Forey
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Thorsten H Ecke
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Urology, Helios Hospital, Bad Saarow, Germany
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14
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Abuhasanein S, Radmann J, Jahnson S, Kjölhede H. Diagnostic Performance of GeneXpert BC as a Triage Test for Patients Presenting with Macroscopic Hematuria Suspicious for Urinary Bladder Cancer: A Multicenter Prospective Case-Control Study. EUR UROL SUPPL 2024; 70:158-166. [PMID: 39554301 PMCID: PMC11567930 DOI: 10.1016/j.euros.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2024] [Indexed: 11/19/2024] Open
Abstract
Background and objective Our objective was to assess whether GeneXpert BC can be used as a triage test to exclude urinary bladder cancer (UBC) for patients with macroscopic hematuria. Methods We conducted a prospective study that include consecutive patients being evaluated for macroscopic hematuria between September 2020 and December 2022. Before cystoscopy, study participants provided a voided urine sample for GeneXpert BC analysis according to a case-control design with an emphasis on UBC detection. Descriptive statistics are reported for patient and tumor characteristics. To assess the diagnostic accuracy of the GeneXpert BC test, the sensitivity, specificity, and negative predictive value (NPV) were calculated, using the histopathologically proven UBC as the ground truth. Key findings and limitations In total, 1505 subjects presenting with macroscopic hematuria were enrolled in the study. After randomization and exclusions, GeneXpert BC testing was carried out for 312 participants. Of these, 151 patients from the case arm had UBC, 122 patients from the control arm (random 10%) were negative for UBC, and 39 patients from the case arm did not have malignancy. Using a predefined linear discriminant analysis (LDA) threshold of ≥0.22, the test had sensitivity of 0.94 (95% confidence interval [CI] 0.90-0.97), specificity of 0.52 (95% CI 0.42-0.59), and NPV of 0.99 (95% CI 0.98-0.99). All false-negative tumors were of low grade (Ta grade 1-2). Cystoscopy and computed tomography urography could have been omitted in 44% of the patients with macroscopic hematuria. At a secondary LDA threshold of ≥0.45, the test had sensitivity of 0.79 (95% CI 0.73-0.86), specificity of 0.83 (95% CI 0.76-0.89), and NPV of 0.97 (95% CI 0.96-0.98). Conclusions and clinical implications GeneXpert BC is a reliable triage test for deciding on whether further investigations are necessary in patients with macroscopic hematuria. Patient summary We assessed a test called GeneXpert BC for the detection of bladder cancer in patients with blood in their urine. GeneXpert BC performed well in ruling out bladder cancer for patients who did not have cancer according to further tests. Use of GeneXpert BC could help in avoiding scans and invasive tests for patients with a negative result.
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Affiliation(s)
- Suleiman Abuhasanein
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Surgery, Urology Section, NU Hospital Group, Region Västra Götaland Health System, Uddevalla, Sweden
| | - Jonatan Radmann
- Department of Urology, Varberg/Halmstad Hospital, Region Halland Health System, Halmstad, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Henrik Kjölhede
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
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15
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Silva-Ferreira M, Carvalho JA, Salta S, Henriques TS, Pereira Rodrigues P, Monteiro-Reis S, Henrique R, Jerónimo C. Diagnostic Test Accuracy of Urinary DNA Methylation-based Biomarkers for the Detection of Primary and Recurrent Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2024; 10:922-934. [PMID: 38897871 DOI: 10.1016/j.euf.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Diagnosis of primary and relapsed bladder carcinomas is accomplished by urethrocystoscopy, an invasive procedure, combined with urinary cytology, with limited sensitivity, resulting in a substantial burden. Thus, noninvasive biomarkers have been investigated, among which DNA methylation has shown promise. This systematic review and meta-analysis sought to assess the diagnostic accuracy of DNA methylation biomarkers reported in the literature for bladder cancer detection, pinpointing the most informative one. METHODS The search for this systematic review and meta-analysis was conducted on PubMed, Scopus, and Cochrane Library for relevant studies published until December 31, 2022. A meta-analysis was performed using a random-effect model, to compute the pooled sensitivity and specificity of the markers. PROSPERO's registration ID for the study is CRD42023397703. KEY FINDINGS AND LIMITATIONS Out of the 2297 studies retrieved, 68 were included in the final analysis, despite considerable heterogeneity. These involved 12 696 participants, of whom 5557 were diagnosed with bladder cancer. Using diagnostic odds ratio (DOR) as a comparative measure, the five most promising markers (pooled sensitivity, specificity, and DOR) were SALL3 (61%, 97%, and 55.67, respectively), PENK (77%, 93%, and 47.90, respectively), ZNF154 (87%, 90%, and 45.07, respectively), VIM (82%, 90%, and 44.81, respectively), and POU4F2 (81%, 89%, and 34.89, respectively). Urinary cytology identified bladder cancer with 55% sensitivity, 92% specificity, and 14.37 DOR. CONCLUSIONS AND CLINICAL IMPLICATIONS DNA methylation biomarkers disclose high accuracy for bladder cancer detection in urine. Nonetheless, validation studies in different clinical settings are scarce, hampering clinical use. The identified biomarkers should be prioritized in future validation studies. PATIENT SUMMARY In this meta-analysis, we include previously published studies that used urine samples of bladder cancer patients' from all around the globe. We were able to compare the diagnostic accuracy of noninvasive markers across different populations. We were able to conclude on the most promising DNA methylation markers to detect bladder cancer using urine.
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Affiliation(s)
- Mariana Silva-Ferreira
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Master Program in Oncology, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - João A Carvalho
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Doctoral Program in Medical Science, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Department of Urology & Urology Clinics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Sofia Salta
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Doctoral Program in Pathology and Molecular Genetics, ICBAS - School of Medicine and Biomedical Sciences - University of Porto, Porto, Portugal
| | - Teresa S Henriques
- CINTESIS@RISE - Health Research Network & MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Pereira Rodrigues
- CINTESIS@RISE - Health Research Network & MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sara Monteiro-Reis
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Porto, Portugal
| | - Rui Henrique
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, IPO Porto Research Center of IPO Porto (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center - Raquel Seruca (Porto.CCC) & CI-IPOP@RISE (Health Research Network), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
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16
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Chiang CH, Chang YC, Peng CY, Wang SS, Jaroenlapnopparat A, Wang JCH, Jou CL, Tang PU, Hsia YP, Chiang CH, Chiang CH. Clinical performance of Bladder EpiCheck™ versus voided urine cytology for detecting recurrence of nonmuscle invasive bladder cancer: Systematic review and meta-analysis. Urol Oncol 2024; 42:449.e21-449.e28. [PMID: 39168785 DOI: 10.1016/j.urolonc.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 06/24/2024] [Accepted: 07/07/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Nonmuscle invasive bladder cancer (NMIBC) has a favorable prognosis but has high propensity for recurrence. Recent development in one of the urinary biomarker tests, Bladder EpiCheck™, offers a noninvasive and accurate method to detect NMIBC recurrence. In this study, we aimed to compare the diagnostic performance of Bladder EpiCheck™ with urine cytology to detect NMIBC recurrence. METHODS We performed a systematic review search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to July 2023. Diagnostic accuracy was defined by sensitivity, negative predictive value (NPV), specificity, and positive predictive value (PPV). RESULTS A total of 6 studies involving 1588 patients were included. Bladder EpiCheck™ has a sensitivity and specificity of 0.81 (95% CI: 0.63-0.91; I2: 43%) and 0.87 (95% CI: 0.83-0.91; I2: 20%), respectively. On the other hand, urine cytology has a sensitivity and specificity of 0.63 (95% CI: 0.29-0.87; I2: 61%) and 0.97 (95% CI: 0.78-1.00; I2: 79%), respectively. EpiCheck™ has a higher NPV (0.94 (95% CI: 0.87-0.97) vs. 0.84 (95% CI: 0.80-0.87) though a lower PPV (0.62 (95% CI: 0.45-0.76) vs. 0.87 (95% CI: 0.56-0.97) than urine cytology. In our subgroup analysis, the sensitivity of Bladder EpiCheck™ for detecting high-grade tumors improved to 0.90 (95% CI: 0.83-0.94) while that for urine cytology improved to 0.72 (95% CI: 0.50-0.87). CONCLUSION Bladder EpiCheck™ has a high sensitivity and NPV for detecting recurrence among patients with NMIBC.
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Affiliation(s)
- Cho-Han Chiang
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yu-Cheng Chang
- Department of Medicine, Danbury Hospital, Danbury, Connecticut
| | - Chun-Yu Peng
- Department of Medicine, Danbury Hospital, Danbury, Connecticut
| | - Shih-Syuan Wang
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York City, New York
| | | | - Jeff Chun Hao Wang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen Liang Jou
- Department of Medical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pui-Un Tang
- Department of Pediatrics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yuan Ping Hsia
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Cho-Hsien Chiang
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan; London School of Hygiene and Tropical Medicine, London, UK
| | - Cho-Hung Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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17
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Gontero P, Birtle A, Capoun O, Compérat E, Dominguez-Escrig JL, Liedberg F, Mariappan P, Masson-Lecomte A, Mostafid HA, Pradere B, Rai BP, van Rhijn BWG, Seisen T, Shariat SF, Soria F, Soukup V, Wood R, Xylinas EN. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-A Summary of the 2024 Guidelines Update. Eur Urol 2024; 86:531-549. [PMID: 39155194 DOI: 10.1016/j.eururo.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND AND OBJECTIVE This publication represents a summary of the updated 2024 European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ. The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. METHODS For the 2024 guidelines on NMIBC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with NMIBC. The guidelines stress the importance of defining patients' risk stratification and treating them appropriately. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of NMIBC. These guidelines are designed for effective integration into clinical practice.
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Affiliation(s)
- Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy.
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Fredrik Liedberg
- Institute of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Western General Hospital, The University of Edinburgh, Edinburgh, UK
| | | | - Hugh A Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Benjamin Pradere
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thomas Seisen
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Robert Wood
- EAU Guidelines Office, Arnhem, The Netherlands
| | - Evanguelos N Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
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18
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Jaszek N, Bogdanowicz A, Siwiec J, Starownik R, Kwaśniewski W, Mlak R. Epigenetic Biomarkers as a New Diagnostic Tool in Bladder Cancer-From Early Detection to Prognosis. J Clin Med 2024; 13:7159. [PMID: 39685620 DOI: 10.3390/jcm13237159] [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: 10/22/2024] [Revised: 11/20/2024] [Accepted: 11/24/2024] [Indexed: 12/18/2024] Open
Abstract
Bladder cancer (BC) currently ranks as the 9th most common cancer worldwide. It is characterised by very high rates of recurrence and metastasis. Most cases of BC are of urothelial origin, and due to its ability to penetrate muscle tissue, BC is divided into non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC). The current diagnosis of BC is still based primarily on invasive cystoscopy, which is an expensive and invasive method that carries a risk of various complications. Urine sediment cytology is often used as a complementary test, the biggest drawback of which is its very low sensitivity concerning the detection of BC at early stages, which is crucial for prompt implementation of appropriate treatment. Therefore, there is a great need to develop innovative diagnostic techniques that would enable early detection and accurate prognosis of BC. Great potential in this regard is shown by epigenetic changes, which are often possible to observe long before the onset of clinical symptoms of the disease. In addition, these changes can be detected in readily available biological material, such as urine or blood, indicating the possibility of constructing non-invasive diagnostic tests. Over the past few years, many studies have emerged using epigenetic alterations as novel diagnostic and prognostic biomarkers of BC. This review provides an update on promising diagnostic biomarkers for the detection and prognosis of BC based on epigenetic changes such as DNA methylation and expression levels of selected non-coding RNAs (ncRNAs), taking into account the latest literature data.
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Affiliation(s)
- Natalia Jaszek
- Department of Laboratory Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
| | - Alicja Bogdanowicz
- Department of Laboratory Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jan Siwiec
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Radosław Starownik
- Department of Urology and Urological Oncology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Wojciech Kwaśniewski
- Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
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19
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Beijert IJ, Wever BMM, Hentschel AE, van den Burgt Y, Kauer PC, Lissenberg-Witte BI, van Moorselaar RJA, Steenbergen RDM, Nieuwenhuijzen JA. Bladder cancer detection in urine by novel methylation markers. Sci Rep 2024; 14:28705. [PMID: 39567591 PMCID: PMC11579363 DOI: 10.1038/s41598-024-77781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 10/25/2024] [Indexed: 11/22/2024] Open
Abstract
Although cystoscopy is a reliable tool for detecting bladder cancer (BC) in patients with hematuria, it is invasive, costly and often unnecessary since most patients with hematuria do not have BC. Consequently, developing urinary biomarkers for non-invasive BC detection is a major clinical need. While DNA methylation markers hold promise, diagnostic performance can still be improved. We assessed 11 candidate methylation markers for urinary BC detection. Urine samples from 77 primary BC patients and 69 controls were used for marker selection and training, with independent validation conducted on samples from 63 primary BC patients and 71 controls. Samples were self-collected at home, mailed to the hospital and analyzed via quantitative methylation-specific polymerase chain reaction. Marker performance was evaluated through univariable and multivariable logistic regression analyses. Decision curve analysis (DCA) gauged clinical utility by potential cystoscopy reduction. Evaluation identified three most promising markers: NRN1, GALR1, and HAND2. These markers exhibited significantly elevated methylation levels in BC compared to controls in both cohorts (P < 0.001). The combined marker set demonstrated an area under the curve (AUC) of 0.94 at 84% (95% CI: 76-92%) sensitivity and 96% (95% CI: 91-100%) specificity. Validation yielded nearly equivalent accuracy (AUC 0.89, sensitivity 76% (95% CI: 65-86%), specificity 93% (95% CI: 86-99%)). DCA indicated a potential of 20 to 35% reduction in cystoscopies depending on the clinical scenario. The excellent diagnostic potential of our methylation markers for non-invasive BC detection, emphasizes their significance for future diagnostic strategies.
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Affiliation(s)
- Irene J Beijert
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
| | - Birgit M M Wever
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Anouk E Hentschel
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Yara van den Burgt
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Paul C Kauer
- Department of Urology, OLVG, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R Jeroen A van Moorselaar
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Renske D M Steenbergen
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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20
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Tang H, Liu X, Ke J, Tang Y, Luo S, Li XK, Huang M. New perspectives of exosomes in urologic malignancies - Mainly focus on biomarkers and tumor microenvironment. Pathol Res Pract 2024; 263:155645. [PMID: 39476607 DOI: 10.1016/j.prp.2024.155645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/09/2024] [Accepted: 10/02/2024] [Indexed: 11/10/2024]
Abstract
Bladder cancer (BCa) and renal cell carcinoma (RCC) are prevalent urologic malignancies (UM) characterized by high morbidity and frequent recurrence. Current diagnostic approaches, often invasive, often indicate an advanced disease stage. And the complex tumor microenvironment often promotes tumor progression and induces resistance to chemotherapy. Current diagnostic and therapeutic modalities often fail to achieve satisfactory outcomes for patients. Exosomes transport diverse cargoes, including cytokines, proteins, lipids, non-coding RNAs, and microRNAs, crucial for intercellular communication. Exosomes have shown potential as biomarkers for UM, participating in tumor progression, especially within the tumor microenvironment (TME), including tumor cell apoptosis, proliferation, migration, invasion, depletion of immune cell function, epithelial-mesenchymal transition (EMT), angiogenesis, and more.In this review, we summarize research advances related to exosomes in UM, focusing on the role of exosomes as biomarkers in bladder and renal cancer, highlighting their significance within the TME.
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Affiliation(s)
- Hai Tang
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xing Liu
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Jingwei Ke
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Yiquan Tang
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Songtao Luo
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Xu Kun Li
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Mingwei Huang
- Urology department, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
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21
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Haas M, Kriegmair MC, Breyer J, Sikic D, Wezel F, Roghmann F, Brehmer M, Wirtz RM, Jarczyk J, Erben P, Bahlinger V, Goldschmidt F, Fechner G, Chen J, Paxinos E, Bates M, Zengerling F, Bolenz C, Burger M, Hartmann A, Eckstein M. Improving detection of carcinoma in situ in bladder cancer: urinary cytology vs the Xpert® BC Monitor. BJU Int 2024; 134:755-762. [PMID: 38717014 DOI: 10.1111/bju.16389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
OBJECTIVE To investigate and compare the performance of urinary cytology and the Xpert BC Monitor test in the detection of bladder cancer in various clinically significant patient cohorts, including patients with carcinoma in situ (CIS), in a prospective multicentre setting, aiming to identify potential applications in clinical practice. PATIENTS AND METHODS A total of 756 patients scheduled for transurethral resection of bladder tumour (TURBT) were prospectively screened between July 2018 and December 2020 at six German University Centres. Central urinary cytology and Xpert BC Monitor tests were performed prior to TURBT. The diagnostic performance of urinary cytology and the Xpert BC Monitor was evaluated according to sensitivity (SN), specificity (SC), negative predictive value (NPV) and positive predictive value (PPV). Statistical comparison of urinary cytology and the Xpert BC Monitor was conducted using the McNemar test. RESULTS Of 756 screened patients, 733 (568 male [78%]; median [interquartile range] age 72 [62-79] years) were included. Bladder cancer was present in 482 patients (65.8%) with 258 (53.5%) high-grade tumours. Overall SN, SC, NPV and PPV were 39%, 93%, 44% and 92% for urinary cytology, and 75%, 69%, 59% and 82% for the Xpert BC Monitor. In patients with CIS (concomitant or solitary), SN, SC, NPV and PPV were 59%, 93%, 87% and 50% for urinary cytology, and 90%, 69%, 95% and 50% for the Xpert BC Monitor. The Xpert BC Monitor missed four tumours (NPV = 98%) in patients with solitary CIS, while potentially avoiding 63.3% of TURBTs in inconclusive or negative cystoscopy and a negative Xpert result. CONCLUSION Positive urinary cytology may indicate bladder cancer and should be taken seriously. The Xpert BC Monitor may represent a useful diagnostic tool for correctly identifying patients with solitary CIS and unsuspicious or inconclusive cystoscopy.
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Affiliation(s)
- Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- Urological Hospital Munich-Planegg, Munich, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Wezel
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Mirco Brehmer
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
- Institute of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Veronika Bahlinger
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Franziska Goldschmidt
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Guido Fechner
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Jack Chen
- Biostatistics, Cepheid Inc., Sunnyvale, CA, USA
| | - Ellen Paxinos
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | | | - Christian Bolenz
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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22
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Carbonell E, Mercader C, Alfambra H, Narvaez P, Villalba E, Pagès R, Asiain I, Costa M, Franco A, Alcaraz A, Ribal MJ, Vilaseca A. The Role of Bladder-Washing Cytology as an Adjunctive Method to Cystoscopy During Follow-Up for Low-Grade TaT1 Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2024; 16:3708. [PMID: 39518145 PMCID: PMC11545547 DOI: 10.3390/cancers16213708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The role of urine cytology during follow-up for low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is not well established, although cytology has low sensitivity in detecting LG recurrences. Our study aims to evaluate the impact of urine cytology as a complementary method to cystoscopy during follow-up for LG NMIBC. METHODS Patients diagnosed with primary LG TaT1 bladder cancer (BC) between 2010 and 2020 were included. Patients were stratified according to the EAU NMIBC scoring model. Urine cytology was performed during follow-up cystoscopy. The outcomes of the study were BC recurrence and upgrading to high-grade (HG). Cytology utility was established by assessing whether its result led to management change. RESULTS We included 337 patients with LG TaT1 BC. EAU risk group distribution was low in 262 (77.7%), intermediate in 57 (16.9%), and high-risk in 18 (5.3%) cases. With a median follow-up of 5 years, 166 (49.3%) patients experienced recurrence. Cystoscopy was positive in 154 (92.8%) and suspicious in 12 (7.2%) cases. Urine cytology was positive in 33 (19.9%) cases but only changed management in 3 (0.89%), all with suspicious cystoscopy. Positive cytology at first recurrence was associated with higher risk of upgrading during follow-up (HR 2.781, p = 0.006) and lower upgrading-free survival (p = 0.001). CONCLUSIONS The role of urine cytology to detect first recurrences during follow-up for primary LG TaT1 NMIBC might be limited to patients with non-conclusive lesions in the cystoscopy. A positive cytology at first recurrence is associated with a higher risk of upgrading to HG BC during follow-up.
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23
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Wang Y, Zheng J, Liu Y, Li D, Jin D, Luan H. Atypical cells in urine sediment: a novel biomarker for early detection of bladder cancer. Clin Chem Lab Med 2024:cclm-2024-0650. [PMID: 39301615 DOI: 10.1515/cclm-2024-0650] [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: 05/29/2024] [Accepted: 08/11/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES Atypical cells (Atyp.C), as a new parameter determined by an automated urine analyzer, can be suspected of being malignant tumor cells. We evaluated the extent to which the Atyp.C can predict the existence of malignant tumor cells. METHODS A total of 3,315 patients (1,751 in the training cohort and 1,564 in the testing cohort) were recruited and divided into five groups, namely, primary bladder cancer (BCa), recurrent BCa, post-treatment monitoring of BCa, other urological tumors, and controls. Urine Atyp. C, bacteria, white blood cell, and red blood cell were measured by a Sysmex UF-5000 analyzer. We compared the Atyp.C values across the different groups, sexes, and tumor stages. The diagnostic performance of Atyp.C alone and in combination with other parameters for detecting BCa was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS The Atyp.C value of the primary BCa group was significantly higher than that in the other groups, except recurrent BCa group. The Atyp.C value was closely related to tumor staging. Atyp.C combined with bacteria had the highest diagnostic performance for primary BCa [training cohort AUC: 0.781 (95 % CI: 0.761-0.801); testing cohort AUC: 0.826 (95 % CI: 0.806-0.845)]. The AUC value of diagnosed recurrent BCa by Atyp.C plus bacteria for the training cohort was 0.784 (95 % CI: 0.762-0.804). CONCLUSIONS Atyp.C was high in primary BCa patients and the combination of bacteria and Atyp.C showed high predictive value for primary BCa, suggesting that Atyp.C may be a useful objective indicator for the early detection of BCa.
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Affiliation(s)
- Yinling Wang
- National Clinical Research Center for Laboratory Medicine, Department of Laboratory Medicine, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
- Research Unit of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, P.R. China
| | - Jun Zheng
- National Clinical Research Center for Laboratory Medicine, Department of Laboratory Medicine, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
- Research Unit of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, P.R. China
| | - Yang Liu
- Department of Urology, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
| | - Dongqi Li
- Department of Clinical Laboratory Diagnostics, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
| | - Danning Jin
- National Clinical Research Center for Laboratory Medicine, Department of Laboratory Medicine, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
- Research Unit of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, P.R. China
| | - Hong Luan
- National Clinical Research Center for Laboratory Medicine, Department of Laboratory Medicine, 159407 The First Hospital of China Medical University , Shenyang, Liaoning, P.R. China
- Research Unit of Medical Laboratory, Chinese Academy of Medical Sciences, Shenyang, P.R. China
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24
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Ciaparrone C, Maffei E, L'Imperio V, Pisapia P, Eloy C, Fraggetta F, Zeppa P, Caputo A. Computer-assisted urine cytology: Faster, cheaper, better? Cytopathology 2024; 35:634-641. [PMID: 38894608 DOI: 10.1111/cyt.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
Recent advancements in computer-assisted diagnosis (CAD) have catalysed significant progress in pathology, particularly in the realm of urine cytopathology. This review synthesizes the latest developments and challenges in CAD for diagnosing urothelial carcinomas, addressing the limitations of traditional urinary cytology. Through a literature review, we identify and analyse CAD models and algorithms developed for urine cytopathology, highlighting their methodologies and performance metrics. We discuss the potential of CAD to improve diagnostic accuracy, efficiency and patient outcomes, emphasizing its role in streamlining workflow and reducing errors. Furthermore, CAD tools have shown potential in exploring pathological conditions, uncovering novel biomarkers and prognostic/predictive features previously unknown or unseen. Finally, we examine the practical issues surrounding the integration of CAD into clinical practice, including regulatory approval, validation and training for pathologists. Despite the promising results, challenges remain, necessitating further research and validation efforts. Overall, CAD presents a transformative opportunity to revolutionize diagnostic practices in urine cytopathology, paving the way for enhanced patient care and outcomes.
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Affiliation(s)
- Chiara Ciaparrone
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Elisabetta Maffei
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Milan, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
| | | | - Pio Zeppa
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Alessandro Caputo
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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25
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Linscott JA, Miyagi H, Murthy PB, Yao S, Grass GD, Vosoughi A, Xu H, Wang X, Yu X, Yu A, Zemp L, Gilbert SM, Poch MA, Sexton WJ, Spiess PE, Li R. From Detection to Cure - Emerging Roles for Urinary Tumor DNA (utDNA) in Bladder Cancer. Curr Oncol Rep 2024; 26:945-958. [PMID: 38837106 DOI: 10.1007/s11912-024-01555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW This review sought to define the emerging roles of urinary tumor DNA (utDNA) for diagnosis, monitoring, and treatment of bladder cancer. Building from early landmark studies the focus is on recent studies, highlighting how utDNA could aid personalized care. RECENT FINDINGS Recent research underscores the potential for utDNA to be the premiere biomarker in bladder cancer due to the constant interface between urine and tumor. Many studies find utDNA to be more informative than other biomarkers in bladder cancer, especially in early stages of disease. Points of emphasis include superior sensitivity over traditional urine cytology, broad genomic and epigenetic insights, and the potential for non-invasive, real-time analysis of tumor biology. utDNA shows promise for improving all phases of bladder cancer care, paving the way for personalized treatment strategies. Building from current research, future comprehensive clinical trials will validate utDNA's clinical utility, potentially revolutionizing bladder cancer management.
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Affiliation(s)
- Joshua A Linscott
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Hiroko Miyagi
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Prithvi B Murthy
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sijie Yao
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hongzhi Xu
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xiaoqing Yu
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alice Yu
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Logan Zemp
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Su W, Xu C, Hu J, Chen Q, Yang Y, Ji M, Fei Y, Ma J, Jiang H, Mi L. Non-invasive screening of bladder cancer using digital microfluidics and FLIM technology combined with deep learning. JOURNAL OF BIOPHOTONICS 2024:e202400192. [PMID: 38938144 DOI: 10.1002/jbio.202400192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
Non-invasive screening for bladder cancer is crucial for treatment and postoperative follow-up. This study combines digital microfluidics (DMF) technology with fluorescence lifetime imaging microscopy (FLIM) for urine analysis and introduces a novel non-invasive bladder cancer screening technique. Initially, the DMF was utilized to perform preliminary screening and enrichment of urine exfoliated cells from 54 participants, followed by cell staining and FLIM analysis to assess the viscosity of the intracellular microenvironment. Subsequently, a deep learning residual convolutional neural network was employed to automatically classify FLIM images, achieving a three-class prediction of high-risk (malignant), low-risk (benign), and minimal risk (normal) categories. The results demonstrated a high consistency with pathological diagnosis, with an accuracy of 91% and a precision of 93%. Notably, the method is sensitive for both high-grade and low-grade bladder cancer cases. This highly accurate non-invasive screening method presents a promising approach for bladder cancer screening with significant clinical application potential.
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Affiliation(s)
- Wenhua Su
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chenyang Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinzhong Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiushu Chen
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yuwei Yang
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
| | - Mingmei Ji
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yiyan Fei
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
| | - Jiong Ma
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
- Institute of Biomedical Engineering and Technology, Academy for Engineer and Technology, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Industrial Microorganisms, The Multiscale Research Institute of Complex Systems (MRICS), School of Life Sciences, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lan Mi
- Department of Optical Science and Engineering, Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), School of Information Science and Technology, Fudan University, Shanghai, China
- Institute of Biomedical Engineering and Technology, Academy for Engineer and Technology, Fudan University, Shanghai, China
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Schroeck FR, Grubb R, MacKenzie TA, Ould Ismail AA, Jensen L, Tsongalis GJ, Lotan Y. Clinical Trial Protocol for "Replace Cysto": Replacing Invasive Cystoscopy with Urine Testing for Non-muscle-invasive Bladder Cancer Surveillance-A Multicenter, Randomized, Phase 2 Healthcare Delivery Trial Comparing Quality of Life During Cancer Surveillance with Xpert Bladder Cancer Monitor or Bladder EpiCheck Urine Testing Versus Frequent Cystoscopy. EUR UROL SUPPL 2024; 63:19-30. [PMID: 38558761 PMCID: PMC10981003 DOI: 10.1016/j.euros.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
"Replace Cysto" is a multisite randomized phase 2 trial including 240 participants with low-grade intermediate-risk non-muscle-invasive bladder cancer, in which participants will be randomized 1:1:1 to one of two urine marker-based approaches alternating a urine marker test (Xpert Bladder Cancer Monitor or Bladder EpiCheck) with cystoscopy or to frequent scheduled cystoscopy. The primary objective is to determine whether urinary quality of life after surveillance is significantly improved in the urine marker arms. The primary outcome will be the patient-reported urinary quality of life domain score of the validated QLQ-NMIBC24 instrument, measured 1-3 d after surveillance. Exploratory outcomes include discomfort after surveillance, the number of invasive procedures that participants undergo per 1000 person years, complications from these procedures per 1000 person years, nonurinary quality of life, acceptability of surveillance, and bladder cancer recurrence and progression. Comparators include surveillance using (1) the Xpert Bladder Cancer Monitor test, (2) the Bladder EpiCheck urinary marker, or (3) frequent cystoscopy alone. After a negative cystoscopy ≤4 mo following bladder tumor resection, all the participants will undergo surveillance at 6, 12, 18, and 24 mo (with time zero defined as the date of the most recent bladder tumor resection). In the urine marker arms, surveillance at 6 and 18 mo will be performed with the marker. Regardless of the arm, participants will undergo cystoscopy at 12 and 24 mo. End of study for each participant will be their 24-mo cystoscopy. Overall trial duration is estimated at 5 yr from when the study opens to enrollment until completion of data analyses. The trial is registered at clinicaltrials.gov (NCT05796375).
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Affiliation(s)
- Florian R. Schroeck
- White River Junction VA Medical Center, White River Junction, VT, USA
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Robert Grubb
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Todd A. MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Data Science, Dartmouth College, Lebanon, NH, USA
| | | | - Laura Jensen
- White River Junction VA Medical Center, White River Junction, VT, USA
| | - Gregory J. Tsongalis
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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Kim DH, Choi MS, Choi JH, Lee C, Jeh SU, Kam SC, Hwa JS, Hyun JS, Choi SM. Correlation between urine cytology results on the day after overnight continuous saline irrigation following transurethral resection of bladder tumor and bladder tumor recurrence. Investig Clin Urol 2024; 65:279-285. [PMID: 38714518 PMCID: PMC11076798 DOI: 10.4111/icu.20230284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 01/22/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To investigate the relationship between urine cytology results after overnight continuous saline irrigation (OCSI) following transurethral resection of bladder tumor (TURBT) and bladder tumor recurrence in non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS A retrospective study was conducted on patients diagnosed with NMIBC between 2016 and 2020 after undergoing TURBT at our hospital. All patients received OCSI following TURBT and had urine cytology test at postoperative 1 day. Urine cytology was classified into three groups: Negative, low-grade urothelial neoplasm (LGUN)+atypical urothelial cells (AUC), and suspicious for high-grade urothelial carcinoma (SHGUC)+high-grade urothelial carcinoma (HGUC). Recurrence-free survival (RFS) in each group was compared using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate independent prognostic factors. RESULTS A total of 172 patients were included in this study. Based on urine cytology group (after OCSI), RFS did not reach the median value in the Negative group. In the LGUN+AUC group, the median RFS was 615.00 days. In the SHGUC+HGUC group, the median RFS was 377.00 days. In survival analysis, the Negative group had a longer RFS than the SHGUC+HGUC group (p=0.013). However, Cox regression analysis showed that SHGUC+HGUC was not an independent prognostic factor for recurrence. CONCLUSIONS Urine cytology results after OCSI following TURBT in NMIBC were associated with bladder tumor recurrence. Specifically, SHGUC or HGUC in urine cytology after OCSI showed earlier recurrence than negative cases. However, further research is needed to accurately determine whether it is an independent prognostic factor.
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Affiliation(s)
- Dae Hyun Kim
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Min Sung Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jae Hwi Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Chunwoo Lee
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Sung Chul Kam
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jeong Seok Hwa
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea.
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Rt R, Sharma A, Biswal D, Goel S. Comparison of narrow band imaging versus white light imaging in detecting non muscle invasive bladder cancer. Urologia 2024; 91:289-297. [PMID: 38372242 DOI: 10.1177/03915603241232115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the present study, we compared Narrow Band Imaging (NBI) and White Light Cystoscopy (WLC) in Non-muscle invasive bladder cancer (NMIBC) for detection and its impact on recurrence. MATERIALS AND METHODS This prospective study was conducted in the department of Urology at a tertiary institution from August 2021 to April 2023. The main aim was to determine the benefit of addition of NBI during TURBT in NMIBC. All patients with Urinary Bladder Mass (size less than 5 cm on USG/CT) aged >18 years of age planned for TURBT were included. RESULTS Amongst 63 patients, the mean age was 59.84 ± 11.3 years; 80% were males. Sixty percent of patients had history of Tobacco consumption and Type II DM was the most common comorbidity (59%). Commonest symptom was gross haematuria. Posterior wall was most commonly involved and papillary lesions were commonest. A total of 125 lesions were identified on WLI, with mean 1.98 ± 1.75 and 78 additional lesions were identified only on NBI with mean 1.24 ± 1.63 lesions. Four patients had intra-operative complications. Five patients had recurrence at 6 weeks and eight patients had recurrence at 3 months. NBI had detected more lesions in patients who developed recurrence at 6 weeks and 3 months (mean: 1.41 and 1.43). CONCLUSION NBI has additive role in detecting NMIBC lesions missed on WLI. NBI has significant role in preventing recurrence at 3 months and more so by detecting high grade tumours.
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Affiliation(s)
- Raghavendra Rt
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Amit Sharma
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Saryu Goel
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
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30
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Yang Y, Li J, Yao W, Zou G, Ye X, Mo Q. Diagnostic value of urine cyclic RNA-0071196 for bladder urothelial carcinoma. BMC Urol 2024; 24:88. [PMID: 38627689 PMCID: PMC11020766 DOI: 10.1186/s12894-024-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the diagnostic value of urine cyclic RNA-0071196 (circRNA-0071196) in the patients with bladder urothelial carcinoma (BUC). METHOD The expression of circRNA-0071196 was detected in the urine samples using qRT-PCR from 40 BUC patients and 30 non-UBC patients at our department from December 2018 to September 2021. The expression difference of circRNA-0071196 was compared between the two groups, and the relationship between the expression of circRNA-0071196 in the urine of UBC patients and the clinical pathological characteristics was analyzed. RESULTS (1) The expression of circRNA-0071196 in the urine of BUC group was significantly higher than that in the non-BUC group (P < 0.05). (2) The expression of circRNA-0071196 in the urine of BUC group was not related to age, sex, or lymph node metastasis (P > 0.05). (3) The expression of circRNA-0071196 in the urine of BUC group was related to tumor T stage, tumor grade and muscle invasion. (4) The urine circRNA-0071196 expression effectively distinguished BUC patients from non-BUC patients. CONCLUSION The elevated expression of urine circRNA-0071196 in BUC patients indicates that circRNA-0071196 has promising potential as a non-invasive urinary biomarker for detecting BUC.
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Affiliation(s)
- Yang Yang
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China
| | - Jun Li
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China
| | - Weixiang Yao
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China
| | - Ge Zou
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China
| | - Xuying Ye
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China
| | - Qishan Mo
- Department of Urology, Panyu District Central Hospital, No.8 Fuyu East Road, Guangzhou, 510000, China.
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Han H, Oh TJ, Heo JE, Lee J, Jang WS, Lee SH, Ham WS, Hwang J, An S, Choi YD. Clinical Validation of the Proenkephalin ( PENK) Methylation Urine Test for Monitoring Recurrence of Non-muscle-invasive Bladder Cancer. EUR UROL SUPPL 2024; 62:99-106. [PMID: 38496823 PMCID: PMC10940910 DOI: 10.1016/j.euros.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective To assess the effectiveness of a urine-based proenkephalin (PENK) methylation test using linear target enrichment-quantitative methylation-specific polymerase chain reaction (mePENK test) for detection of non-muscle-invasive bladder cancer (NMIBC) recurrence compared to cytology and the NMP22 test. Methods We first conducted a retrospective case-control study involving 54 patients with primary BC and 29 healthy individuals. We then prospectively enrolled 186 patients (January to December 2022) undergoing cystoscopy surveillance after transurethral resection of bladder tumor, of whom 59 had recurrent tumors. We analyzed voided urine samples for PENK methylation levels in urinary DNA. Cystoscopy with histology was used as the reference standard for assessing the diagnostic accuracy of the mePENK test in detecting BC recurrence. We calculated the sensitivity and specificity using receiver operating characteristic curve analysis. Survival differences were determined using the Kaplan-Meier method and Cox proportional-hazards model. A p < 0.05 was considered statistically significant. Key findings and limitations In the case-control study, the PENK test had sensitivity of 83.3% and specificity of 100%. For NMIBC patients undergoing cystoscopy surveillance, the sensitivity was 76.3% (95% confidence interval [CI] 63.4-86.4%) and the specificity was 85% (95% CI 77.6-90.7%), outperforming cytology (sensitivity: 28.8%, 95% CI 17.8-42.1%; p < 0.001; specificity: 97.6%, 95% CI 93.2-99.5%) and the NMP22 test (sensitivity: 54.2%, 95% CI 40.7-67.2%; p = 0.016; specificity 81.9%, 95% CI 74.1-88.2%). In the high-risk group, the mePENK test had sensitivity of 89.7% (95% CI 75.8-97.1%) and a negative predictive value of 96.9%. For the group with low/intermediate risk, the sensitivity was 41.7%. In the group with negative cystoscopy, recurrence-free survival was shorter for patients with positive than for those with negative mePENK results (245 vs 503 d), with a hazard ratio of 9.4 (p < 0.001). The main study limitation is the small sample size. Conclusions and clinical implications The mePENK test showed good performance for detection of NMIBC recurrence and has potential for use for prognosis and prediction. Patient summary We found that a test used to analyze urine samples showed good performance in detecting recurrence of NMIBC. This noninvasive mePENK test may help in personalized follow-up care for patients with NMIBC.
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Affiliation(s)
- Hyunho Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Sungwhan An
- Genomictree, Inc., Daejeon, Republic of Korea
| | - Young-Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tsuji K, Kaneko M, Harada Y, Fujihara A, Ueno K, Nakanishi M, Konishi E, Takamatsu T, Horiguchi G, Teramukai S, Ito-Ihara T, Ukimura O. A Fully Automated Artificial Intelligence System to Assist Pathologists' Diagnosis to Predict Histologically High-grade Urothelial Carcinoma from Digitized Urine Cytology Slides Using Deep Learning. Eur Urol Oncol 2024; 7:258-265. [PMID: 38065702 DOI: 10.1016/j.euo.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Urine cytology, although a useful screening method for urothelial carcinoma, lacks sensitivity. As an emerging technology, artificial intelligence (AI) improved image analysis accuracy significantly. OBJECTIVE To develop a fully automated AI system to assist pathologists in the histological prediction of high-grade urothelial carcinoma (HGUC) from digitized urine cytology slides. DESIGN, SETTING, AND PARTICIPANTS We digitized 535 consecutive urine cytology slides for AI use. Among these slides, 181 were used for AI development, 39 were used as AI test data to identify HGUC by cell-level classification, and 315 were used as AI test data for slide-level classification. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Out of the 315 slides, 171 were collected immediately prior to bladder biopsy or transurethral resection of bladder tumor, and then outcomes were compared with the histological presence of HGUC in the surgical specimen. The primary aim was to compare AI prediction of the histological presence of HGUC with the pathologist's histological diagnosis of HGUC. Secondary aims were to compare the time required for AI evaluation and concordance between the AI's classification and pathologist's cytology diagnosis. RESULTS AND LIMITATIONS The AI capability for predicting the histological presence of HGUC was 0.78 for the area under the curve. Comparing the AI predictive performance with pathologists' diagnosis, the AI sensitivity of 63% for histological HGUC prediction was superior to a pathologists' cytology sensitivity of 46% (p = 0.0037). On the contrary, there was no significant difference between the AI specificity of 83% and pathologists' specificity of 89% (p = 0.13), and AI accuracy of 74% and pathologists' accuracy of 68% (p = 0.08). The time required for AI evaluation was 139 s. With respect to the concordance between the AI prediction and pathologist's cytology diagnosis, the accuracy was 86%. Agreements with positive and negative findings were 92% and 84%, respectively. CONCLUSIONS We developed a fully automated AI system to assist pathologists' histological diagnosis of HGUC using digitized slides. This AI system showed significantly higher sensitivity than a board-certified cytopathologist and may assist pathologists in making urine cytology diagnoses, reducing their workload. PATIENT SUMMARY In this study, we present a deep learning-based artificial intelligence (AI) system that classifies urine cytology slides according to the Paris system. An automated AI system was developed and validated with 535 consecutive urine cytology slides. The AI predicted histological high-grade urothelial carcinoma from digitized urine cytology slides with superior sensitivity than pathologists, while maintaining comparable specificity and accuracy.
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Affiliation(s)
- Keisuke Tsuji
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatomo Kaneko
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuki Harada
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Ueno
- KYOCERA Communication Systems Co., Ltd, Kyoto, Japan
| | | | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuro Takamatsu
- Department of Medical Photonics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiko Ito-Ihara
- Department of Clinical and Translational Research Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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33
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Tomiyama E, Fujita K, Hashimoto M, Uemura H, Nonomura N. Urinary markers for bladder cancer diagnosis: A review of current status and future challenges. Int J Urol 2024; 31:208-219. [PMID: 37968825 DOI: 10.1111/iju.15338] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
Bladder cancer is a common urological cancer with a high recurrence rate that requires long-term follow-up, and early detection positively affects prognosis. To date, the initial diagnosis and follow-up for bladder cancer rely on cystoscopy, which is an invasive and expensive procedure. Therefore, urinary markers for the detection of bladder cancer have attracted research attention for decades to reduce unnecessary cystoscopies. Urine, which is in continuous contact with bladder cancer, is considered a suitable fluid for providing tumor information. Urinary cytology is the only widely used urinary marker in clinical practice; however, it has poor sensitivity for low-grade tumors; indicating the need for novel urinary markers. Considerable research has been conducted on this topic over the years, resulting in a complex landscape with a wide range of urinary markers, including protein-, exfoliated cell-, RNA-, DNA-, and extracellular vesicle-based markers. Although some of these markers have been approved by the U.S. Food and Drug Administration and are commercially available, their use in clinical practice is limited. To facilitate clinical application, potential urinary markers must withstand prospective clinical trials and be easy for patients and clinicians to understand and utilize in a clinical context. This review provides a comprehensive overview of currently available and recently reported promising urinary markers for bladder cancer. Additionally, the challenges and the prospects of these urinary markers for clinical implementation in bladder cancer treatment were discussed.
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Affiliation(s)
- Eisuke Tomiyama
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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Goto Y. Editorial Comment on Urinary markers for bladder cancer diagnosis: A review of current status and future challenges. Int J Urol 2024; 31:219. [PMID: 38071742 DOI: 10.1111/iju.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
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Torres-Bustamante MI, Vazquez-Urrutia JR, Solorzano-Ibarra F, Ortiz-Lazareno PC. The Role of miRNAs to Detect Progression, Stratify, and Predict Relevant Clinical Outcomes in Bladder Cancer. Int J Mol Sci 2024; 25:2178. [PMID: 38396855 PMCID: PMC10889402 DOI: 10.3390/ijms25042178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Bladder cancer (BC) is one of the most common types of cancer worldwide, with significant differences in survival depending on the degree of muscle and surrounding tissue invasion. For this reason, the timely detection and monitoring of the disease are important. Surveillance cystoscopy is an invasive, costly, and uncomfortable procedure to monitor BC, raising the need for new, less invasive alternatives. In this scenario, microRNAs (miRNAs) represent attractive prognostic tools given their role as gene regulators in different biological processes, tissue expression, and their ease of evaluation in liquid samples. In cancer, miRNA expression is dynamically modified depending on the tumor type and cancer staging, making them potential biomarkers. This review describes the most recent studies in the last five years exploring the utility of miRNA-based strategies to monitor progression, stratify, and predict relevant clinical outcomes of bladder cancer. Several studies have shown that multimarker miRNA models can better predict overall survival, recurrence, and progression in BC patients than traditional strategies, especially when combining miRNA expression with clinicopathological variables. Future studies should focus on validating their use in different cohorts and liquid samples.
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Affiliation(s)
| | - Jorge Raul Vazquez-Urrutia
- Department of Medicine, The Pennsylvania State University College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Fabiola Solorzano-Ibarra
- Instituto de Investigación en Enfermedades Crónico Degenerativas, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Estancias Posdoctorales por México, Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONACYT), México City 03940, Mexico
| | - Pablo Cesar Ortiz-Lazareno
- División de Inmunología, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
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Kravchuk AP, Wolff I, Gilfrich C, Wirtz RM, Soares P, Braun KP, Brookman-May SD, Kollitsch L, Hauner K, Burchardt M, Bründl J, Burger M, May M. Urine-Based Biomarker Test Uromonitor ® in the Detection and Disease Monitoring of Non-Muscle-Invasive Bladder Cancer-A Systematic Review and Meta-Analysis of Diagnostic Test Performance. Cancers (Basel) 2024; 16:753. [PMID: 38398144 PMCID: PMC10886463 DOI: 10.3390/cancers16040753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Optimal urine-based diagnostic tests (UBDT) minimize unnecessary follow-up cystoscopies in patients with non-muscle-invasive bladder-cancer (NMIBC), while accurately detecting high-grade bladder-cancer without false-negative results. Such UBDTs have not been comprehensively described upon a broad, validated dataset, resulting in cautious guideline recommendations. Uromonitor®, a urine-based DNA-assay detecting hotspot alterations in TERT, FGFR3, and KRAS, shows promising initial results. However, a systematic review merging all available data is lacking. Studies investigating the diagnostic performance of Uromonitor® in NMIBC until November 2023 were identified in PubMed, Embase, Web-of-Science, Cochrane, Scopus, and medRxiv databases. Within aggregated analyses, test performance and area under the curve/AUC were calculated. This project fully implemented the PRISMA statement. Four qualifying studies comprised a total of 1190 urinary tests (bladder-cancer prevalence: 14.9%). Based on comprehensive analyses, sensitivity, specificity, positive-predictive value/PPV, negative-predictive value/NPV, and test accuracy of Uromonitor® were 80.2%, 96.9%, 82.1%, 96.6%, and 94.5%, respectively, with an AUC of 0.886 (95%-CI: 0.851-0.921). In a meta-analysis of two studies comparing test performance with urinary cytology, Uromonitor® significantly outperformed urinary cytology in sensitivity, PPV, and test accuracy, while no significant differences were observed for specificity and NPV. This systematic review supports the use of Uromonitor® considering its favorable diagnostic performance. In a cohort of 1000 patients with a bladder-cancer prevalence of ~15%, this UBDT would avert 825 unnecessary cystoscopies (true-negatives) while missing 30 bladder-cancer cases (false-negatives). Due to currently limited aggregated data from only four studies with heterogeneous quality, confirmatory studies are needed.
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Affiliation(s)
- Anton P. Kravchuk
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Ralph M. Wirtz
- STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany
| | - Paula Soares
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal
- Department of Pathology and Oncology, Faculty of Medicine, University of Porto, 4200-139 Porto, Portugal
| | - Kay-Patrick Braun
- Institute of General Practice, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany
| | - Sabine D. Brookman-May
- Department of Urology, Ludwig-Maximilians-University, 81377 Munich, Germany
- Johnson and Johnson Innovative Medicine, Research & Development, Spring House, PA 19477, USA
| | - Lisa Kollitsch
- Department of Urology and Andrology, Klinik Donaustadt, A1220 Vienna, Austria
| | - Katharina Hauner
- Department of Urology, University Hospital MRI-TUM (München rechts der Isar), 81675 Munich, Germany
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
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Shah CP, Lord-McKenzie T, Makris A, Trail M, Gray J, Smith G, Mariappan P. The Value of Negative Urinary Dipstick Tests for Haematuria in Patients Undergoing Surveillance for Low-grade Ta Urothelial Cancer: A Two-stage Prospective Clinical Study in 524 Patients. EUR UROL SUPPL 2024; 60:24-31. [PMID: 38375346 PMCID: PMC10874875 DOI: 10.1016/j.euros.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective The risk of first recurrence beyond 5 yr for patients with low-grade (LG) Ta non-muscle-invasive bladder cancer (NMIBC) is low enough to consider discontinuing cystoscopic surveillance at that point. However, a positive urinary dipstick test for haematuria (UDH) during and beyond the period of cystoscopic surveillance can disrupt plans to cease surveillance because the association between UDH positivity and recurrence in LG Ta NMIBC is unknown. In a two-stage study, we evaluated this association and explored the role of UDH negativity in predicting the absence of recurrence. Methods Because of previously demonstrated changes in recurrence patterns over time, two prospective cohorts were assessed: an "exploratory" cohort (January 2007-March 2008) and a "validation" cohort (November 2017-August 2018). UDH was performed before flexible cystoscopy. Patient, operative, and surveillance data have been recorded prospectively using standard pro forma sheets since 1978 in our institution. Only patients with primary LG Ta pTa NMIBC were included for analysis. Key findings and limitations We assessed 231 patients in the exploratory group and 293 in the validation group. The proportion of smokers (67% vs 70%; p = 0.5) and mean follow-up (72.2 vs 79.9 mo; p = 0.2) were similar between the groups. The recurrence rate was higher in the exploratory group (19% vs 11%; p = 0.009), as was the UDH positivity rate (37% vs 11%; p < 0.001). The specificity and negative predictive value were 64% and 83% in the exploratory group, and 90% and 90%, respectively, in the validation group. These values increased further for the subgroup with solitary primary tumours the subgroup without recurrence for 3 yr. Conclusions and clinical implications UDH negativity has a high probability of being associated with the absence of recurrence in small LG Ta NMIBC and could be an inexpensive adjunct during surveillance. Ongoing validation, which started in 2019, is being performed in a now-nationalised Scottish protocol in which UDH replaces cystoscopy in years 2 and 4 for patients in the low-risk group. Patient summary We investigated the accuracy of a dipstick test for blood in the urine for patients undergoing surveillance for low-grade noninvasive bladder cancer. We found that a negative dipstick test result was highly associated with the absence of tumour recurrence, particularly for patients with the lowest risk. These findings have been introduced into a national protocol designed to reduce the frequency of telescopic inspection of the bladder during surveillance to reduce the burden for patients.
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Affiliation(s)
- Chandrarajan Premal Shah
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
| | - Tanya Lord-McKenzie
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Antonios Makris
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Matthew Trail
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Jennifer Gray
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Gordon Smith
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
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Furuya H, Sakatani T, Tanaka S, Murakami K, Waldron RT, Hogrefe W, Rosser CJ. Bladder cancer risk stratification with the Oncuria 10-plex bead-based urinalysis assay using three different Luminex xMAP instrumentation platforms. J Transl Med 2024; 22:8. [PMID: 38167321 PMCID: PMC10763405 DOI: 10.1186/s12967-023-04811-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND No single marker of bladder cancer (BC) exists in urine samples with sufficient accuracy for disease diagnosis and treatment monitoring. The multiplex Oncuria BC assay noninvasively quantifies the concentration of 10 protein analytes in voided urine samples to quickly generate a unique molecular profile with proven BC diagnostic and treatment-tracking utility. Test adoption by diagnostic and research laboratories mandates reliably reproducible assay performance across a variety of instrumentation platforms used in different laboratories. METHODS We compared the performance of the clinically validated Oncuria BC multiplex immunoassay when data output was generated on three different analyzer systems. Voided urine samples from 36 subjects (18 with BC and 18 Controls) were reacted with Oncuria test reagents in three 96-well microtiter plates on Day 1, and consecutively evaluated on the LED/image-based MagPix, and laser/flow-based Luminex 200 and FlexMap 3D (all xMAP instruments from Luminex Corp., Austin, TX) on Day 2. The BC assay uses magnetic bead-based fluorescence technology (xMAP, Multi-analyte profiling; Luminex) to simultaneously quantify 10 protein analytes in urine specimens [i.e., angiogenin (ANG), apolipoprotein E (ApoE), carbonic anhydrase IX (CA9), CXCL8/interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase-10 (MMP-10), serpin A1/alpha-1 anti-trypsin (A1AT), serpin E1/plasminogen activator inhibitor-1 (PAI-1), CD138/syndecan-1 (SDC1), and vascular endothelial growth factor-A (VEGF-A)]. All three analyzers quantify fluorescence signals generated by the Oncuria assay. RESULTS All three platforms categorized all 10 analytes in identical samples at nearly identical concentrations, with variance across systems typically < 5%. While the most contemporary instrument, the FlexMap 3D, output higher raw fluorescence values than the two comparator systems, standard curve slopes and analyte concentrations determined in urine samples were concordant across all three units. Forty-four percent of BC samples registered ≥ 1 analyte above the highest standard concentration, i.e., A1AT (n = 7/18), IL-8 (n = 5), and/or ANG (n = 2), while only one control sample registered an analyte (A1AT) above the highest standard concentration. CONCLUSION Multiplex BC assays generate detailed molecular signatures useful for identifying BC, predicting treatment responsiveness, and tracking disease progression and recurrence. The similar performance of the Oncuria assay across three different analyzer systems supports test adaptation by clinical and research laboratories using existing xMAP platforms. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov as NCT04564781, NCT03193528, NCT03193541, and NCT03193515.
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Affiliation(s)
- Hideki Furuya
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 110 N. George Burns Rd, Davis 2025, Los Angeles, CA, 90048, USA.
- Department of Biomedical Sciences, Cedars‑Sinai Medical Center, Los Angeles, CA, USA.
| | - Toru Sakatani
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 110 N. George Burns Rd, Davis 2025, Los Angeles, CA, 90048, USA
- Department of Urology, Cedars‑Sinai Medical Center, Los Angeles, CA, USA
| | - Sunao Tanaka
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 110 N. George Burns Rd, Davis 2025, Los Angeles, CA, 90048, USA
| | - Kaoru Murakami
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 110 N. George Burns Rd, Davis 2025, Los Angeles, CA, 90048, USA
- Department of Urology, Cedars‑Sinai Medical Center, Los Angeles, CA, USA
| | - Richard T Waldron
- Department of Medicine, Cedars‑Sinai Medical Center, Los Angeles, CA, USA
| | | | - Charles J Rosser
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, 110 N. George Burns Rd, Davis 2025, Los Angeles, CA, 90048, USA
- Department of Urology, Cedars‑Sinai Medical Center, Los Angeles, CA, USA
- Nonagen Bioscience Corp., Los Angeles, CA, USA
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Ecke TH, Meisl CJ, Schlomm T, Rabien A, Labonté F, Rong D, Hofbauer S, Friedersdorff F, Sommerfeldt L, Gagel N, Gössl A, Barski D, Otto T, Grunewald CM, Niegisch G, Hennig MJP, Kramer MW, Koch S, Roggisch J, Hallmann S, Weiß S, Waldner M, Graff J, Veltrup E, Linden F, Hake R, Eidt S, Wirtz RM. BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL as urinary marker for bladder cancer: Final results of a German multicenter study. Urol Oncol 2023; 41:484.e17-484.e26. [PMID: 37407421 DOI: 10.1016/j.urolonc.2023.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION AND OBJECTIVE BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL are urinary-based rapid tests. This multicenter study is the first study comparing all available rapid tests on a large cohort of bladder cancer patients and healthy controls in one setting. METHODS In total 732 urine samples (second morning urine) in a real-world assessment have been analyzed. We evaluated clinical samples from 464 patients with histologically confirmed urothelial tumors of the urinary bladder (17 solitary CIS, 189 low-grade, 187 high-grade nonmuscle invasive, 71 high-grade muscle invasive), 77 patients with No Evidence of Disease (NED), and from 191 healthy controls. Urine samples were analyzed by the BTA stat®, NMP22® BladderChek®, UBC® Rapid Test point-of-care (POC) system using the concile Omega 100 POC reader, and CancerCheck® UBC® rapid VISUAL. Sensitivities and specificities were calculated by contingency analyses. RESULTS All investigated urinary markers detected more pathological concentrations in urine of bladder cancer patients compared to tumor-free patients. The calculated diagnostic sensitivities for BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, CancerCheck® UBC® rapid VISUAL, and cytology were 62.4%, 13.4%, 58.2%, 28.6%, 36.2% for low-grade, 83.4%, 49.5%, 84.5%, 63.1%, 71.2% for high-grade nonmuscle invasive, and 95.8%, 35.2%, 76.1%, 50.7%, 67.7% for high-grade muscle-invasive bladder cancer. The specificity was 67.9%, 95.5%, 79.4%, 94.4%, and 83.7%, respectively. The area under the curve (AUC) after receiver operating characteristics (ROC) analysis for high-grade non-muscle-invasive tumors was 0.757, 0.725, 0.819, 0.787, and 0.774, respectively. CONCLUSIONS The analysis of more than 700 urine samples offers an objective view on urine-based rapid diagnostics. Elevated pathological concentrations of markers in urine of bladder cancer patients were detected in all investigated tests. The highest sensitivities for high-grade non-muscle-invasive tumors were calculated for BTA stat® and UBC® Rapid Test, whereas NMP22® BladderChek®, and cytology showed the highest specificities. BTA stat® and UBC® Rapid Test have the potential to be used as a clinical valuable urinary protein biomarker for the detection of high-grade non-muscle-invasive bladder cancer patients and could be included in the management of these tumors.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany; Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christina J Meisl
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Lilli Sommerfeldt
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nella Gagel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Andreas Gössl
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Dimitri Barski
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany; University Hospital Essen, Essen, Germany
| | - Camilla M Grunewald
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Mario W Kramer
- Department of Urology, University Hospital Lübeck, Lübeck, Germany
| | - Stefan Koch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany; Brandenburg Medical School, Brandenburg, Germany
| | - Jenny Roggisch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany
| | | | - Sarah Weiß
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Johannes Graff
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | - Roland Hake
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
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Furuya H, Sakatani T, Tanaka S, Murakami K, Waldron RT, Hogrefe W, Rosser CJ. Bladder cancer risk stratification with the Oncuria 10-plex bead-based urinalysis assay using three different Luminex xMAP instrumentation platforms. RESEARCH SQUARE 2023:rs.3.rs-3635581. [PMID: 38045238 PMCID: PMC10690323 DOI: 10.21203/rs.3.rs-3635581/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background No single marker of bladder cancer (BC) exists in urine samples with sufficient accuracy for disease diagnosis and treatment monitoring. The multiplex Oncuria BC assay noninvasively quantifies the concentration of 10 protein analytes in voided urine samples to quickly generate a unique molecular profile with proven BC diagnostic and treatment-tracking utility. Test adoption by diagnostic and research laboratories mandates reliably reproducible assay performance across a variety of instrumentation platforms used in different laboratories. Methods We compared the performance of the clinically validated Oncuria BC multiplex immunoassay when data output was generated on three different analyzer systems. Voided urine samples from 36 subjects (18 with BC and 18 Controls) were reacted with Oncuria test reagents in three 96-well microtiter plates on Day 1, and consecutively evaluated on the LED/image-based MagPix, and laser/flow based Luminex 200 and FlexMap 3D (all xMAP instruments from Luminex Corp., Austin, TX) on Day 2. The BC assay uses magnetic bead-based fluorescence technology (xMAP, Multi-analyte profiling; Luminex) to simultaneously quantify 10 protein analytes in urine specimens [i.e., angiogenin (ANG), apolipoprotein E (ApoE), carbonic anhydrase IX (CA9), CXCL8/interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase-10 (MMP-10), serpin A1/alpha-1 anti-trypsin (A1AT), serpin E1/plasminogen activator inhibitor-1 (PAI-1), CD138/syndecan-1 (SDC1), and vascular endothelial growth factor-A (VEGF-A)]. Results All three platforms categorized all 10 analytes in identical samples at nearly identical concentrations, with variance across systems typically <5%. While the most contemporary instrument, the FlexMap 3D, output higher raw fluorescence values than the two comparator systems, standard curve slopes and analyte concentrations determined in urine samples were concordant across all three units. Forty-four percent of BC samples registered ≥1 analyte above the highest standard concentration, i.e., A1AT (n=7/18), IL-8 (n=5), and/or ANG (n=2). In Controls, A1AT was higher in one sample. Conclusion Multiplex BC assays generate detailed molecular signatures useful for identifying BC, predicting treatment esponsiveness, and tracking disease progression and recurrence. The similar performance of the Oncuria assay across three different analyzer systems supports test adaptation by clinical and research laboratories using existing xMAP platforms. Trial Registration This study was registered at ClinicalTrials.gov as NCT04564781, NCT03193528, NCT03193541, and NCT03193515.
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Affiliation(s)
| | - Toru Sakatani
- Cedars-Sinai Comprehensive Cancer Center: Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
| | - Sunao Tanaka
- Cedars-Sinai Comprehensive Cancer Center: Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
| | - Kaoru Murakami
- Cedars-Sinai Comprehensive Cancer Center: Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
| | | | | | - Charles J Rosser
- Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute
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41
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Samara M, Vlachostergios PJ, Thodou E, Zachos I, Mitrakas L, Evmorfopoulos K, Tzortzis V, Giakountis A. Characterization of a miRNA Signature with Enhanced Diagnostic and Prognostic Power for Patients with Bladder Carcinoma. Int J Mol Sci 2023; 24:16243. [PMID: 38003433 PMCID: PMC10671612 DOI: 10.3390/ijms242216243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Bladder carcinoma is globally among the most prevalent cancers and is associated with a high mortality rate at advanced stages. Its detection relies on invasive diagnostic methods that are unpleasant for the patient. Non-invasive molecular biomarkers, such as miRNAs, could serve as alternatives for early detection and prognosis of this malignancy. We designed a computational approach that combines transcriptome profiling, survival analyses, and calculation of diagnostic power in order to isolate miRNA signatures with high diagnostic and prognostic utility. Our analysis of TCGA-BLCA data from 429 patients yielded one miRNA signature, consisting of five upregulated and three downregulated miRNAs with cumulative diagnostic power that outperforms current diagnostic methods. The same miRNAs have a strong prognostic significance since their expression is associated with the overall survival of bladder cancer patients. We evaluated the expression of this signature in 19 solid cancer types, supporting its unique diagnostic utility for bladder carcinoma. We provide computational evidence regarding the functional implications of this miRNA signature in cell cycle regulation, demonstrating its abundance in body fluids, including peripheral blood and urine. Our study characterized a novel miRNA signature with the potential to serve as a non-invasive method for bladder cancer diagnosis and prognosis.
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Affiliation(s)
- Maria Samara
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
| | - Panagiotis J. Vlachostergios
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Lampros Mitrakas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Konstantinos Evmorfopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41335 Larissa, Greece
| | - Antonis Giakountis
- Department of Biochemistry and Biotechnology, University of Thessaly, 41335 Larissa, Greece
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42
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Davalieva K, Kiprijanovska S, Ivanovski O, Trifunovski A, Saidi S, Dimovski A, Popov Z. Proteomics Profiling of Bladder Cancer Tissues from Early to Advanced Stages Reveals NNMT and GALK1 as Biomarkers for Early Detection and Prognosis of BCa. Int J Mol Sci 2023; 24:14938. [PMID: 37834386 PMCID: PMC10573217 DOI: 10.3390/ijms241914938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
The high recurrence rate and invasive diagnostic and monitoring methods in bladder cancer (BCa) clinical management require the development of new non-invasive molecular tools for early detection, particularly for low-grade and low-stage BCa as well as for risk stratification. By using an in-solution digestion method and label-free data-independent LC-MS/MS coupled with ion mobility, we profiled the BCa tissues from initiation to advanced stages and confidently identified and quantified 1619 proteins (≥2 peptides). A statistically significant difference in abundance (Anova ≤ 0.05) showed 494 proteins. Significant correlation with stage with steady up or down with BCa stages showed 15 proteins. Testing of NNMT, GALK1, and HTRA1 in urine samples showed excellent diagnostic potential for NNMT and GALK1 with AUC of 1.000 (95% CI: 1.000-1.000; p < 0.0001) and 0.801 (95% CI: 0.655-0.947; p < 0.0001), respectively. NNMT and GALK1 also showed very good potential in discriminating non-invasive low-grade from invasive high-grade BCa with AUC of 0.763 (95% CI: 0.606-0.921; p = 0.001) and 0.801 (95% CI: 0.653-0.950; p < 0.0001), respectively. The combination of NNMT and GALK1 increased prognostic accuracy (AUC = 0.813). Our results broaden the range of potential novel candidates for non-invasive BCa diagnosis and prognosis.
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Affiliation(s)
- Katarina Davalieva
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
| | - Sanja Kiprijanovska
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
| | - Ognen Ivanovski
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Aleksandar Trifunovski
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Skender Saidi
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Aleksandar Dimovski
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
- Faculty of Pharmacy, University “St. Cyril and Methodius”, 1000 Skopje, North Macedonia
| | - Zivko Popov
- Clinical Hospital “Acibadem Sistina”, 1000 Skopje, North Macedonia;
- Medical Faculty, University “St. Cyril and Methodius”, 1000 Skopje, North Macedonia
- Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia
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Di Gianfrancesco L, Crestani A, Amodeo A, Corsi P, De Marchi D, Miglioranza E, Lista G, Simonetti F, Busetto GM, Maggi M, Pierconti F, Martini M, Montagner IM, Tormen D, Scapinello A, Marino F, Porreca A. The Role of Checkpoint Inhibitor Expression Directly on Exfoliated Cells from Bladder Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:3119. [PMID: 37835862 PMCID: PMC10572290 DOI: 10.3390/diagnostics13193119] [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: 07/18/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Bladder cancer (BCa) is a common type of cancer that affects the urinary bladder. The early detection and management of BCa is critical for successful treatment and patient outcomes. In recent years, researchers have been exploring the use of biomarkers as a non-invasive and effective tool for the detection and monitoring of BCa. One such biomarker is programmed death-ligand 1 (PD-L1), which is expressed on the surface of cancer cells and plays a crucial role in the evasion of the immune system. Studies have shown that the PD-L1 expression is higher in BCa tumors than in healthy bladder tissue. Additionally, PD-L1 expression might even be detected in urine samples in BCa patients, in addition to the examination of a histological sample. The technique is being standardized and optimized. We reported how BCa patients had higher urinary PD-L1 levels than controls by considering BCa tumors expressing PD-L1 in the tissue specimen. The expression of PD-L1 in urinary BCa cells might represent both a diagnostic and a prognostic tool, with the perspective that the PD-L1 expression of exfoliate urinary cells might reveal and anticipate eventual BCa recurrence or progression. Further prospective and longitudinal studies are needed to assess the expression of PD-L1 as a biomarker for the monitoring of BCa patients. The use of PD-L1 as a biomarker for the detection and monitoring of BCa has the potential to significantly improve patient outcomes by allowing for earlier detection and more effective management of the disease.
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Affiliation(s)
- Luca Di Gianfrancesco
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Alessandro Crestani
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Antonio Amodeo
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Paolo Corsi
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Davide De Marchi
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Eugenio Miglioranza
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Giuliana Lista
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | - Francesca Simonetti
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
| | | | - Martina Maggi
- Department of Urology, Sapienza University, 00185 Rome, Italy;
| | - Francesco Pierconti
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, 00168 Rome, Italy;
| | - Maurizio Martini
- Department of Pathology, University of Messina, 98122 Messina, Italy;
| | - Isabella Monia Montagner
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Debora Tormen
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Antonio Scapinello
- Anatomy and Pathological Histology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (I.M.M.); (A.S.)
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, 00168 Rome, Italy;
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology (IOV)—IRCCS, Headquarter of Castelfranco Veneto, 35128 Padua, Italy; (A.C.); (A.A.); (P.C.); (D.D.M.); (E.M.); (G.L.); (F.S.); (A.P.)
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Maas M, Todenhöfer T, Black PC. Urine biomarkers in bladder cancer - current status and future perspectives. Nat Rev Urol 2023; 20:597-614. [PMID: 37225864 DOI: 10.1038/s41585-023-00773-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/26/2023]
Abstract
Urine markers to detect bladder cancer have been the subject of research for decades. The idea that urine - being in continuous contact with tumour tissue - should provide a vector of tumour information remains an attractive concept. Research on this topic has resulted in a complex landscape of many different urine markers with varying degrees of clinical validation. These markers range from cell-based assays to proteins, transcriptomic markers and genomic signatures, with a clear trend towards multiplex assays. Unfortunately, the number of different urine markers and the efforts in research and development of clinical grade assays are not reflected in the use of these markers in clinical practice, which is currently limited. Numerous prospective trials are in progress with the aim of increasing the quality of evidence about urinary biomarkers in bladder cancer to achieve guideline implementation. The current research landscape suggests a division of testing approaches. Some efforts are directed towards addressing the limitations of current assays to improve the performance of urine markers for a straightforward detection of bladder cancer. Additionally, comprehensive genetic analyses are emerging based on advances in next-generation sequencing and are expected to substantially affect the potential application of urine markers in bladder cancer.
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Affiliation(s)
- Moritz Maas
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Tilman Todenhöfer
- Clinical Trials Unit Studienpraxis Urologie, Nürtingen, Germany
- Eberhard-Karls-University, Tübingen, Germany
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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Wu S, Li R, Jiang Y, Yu J, Zheng J, Li Z, Li M, Xin K, Wang Y, Xu Z, Li S, Chen X. Liquid biopsy in urothelial carcinoma: Detection techniques and clinical applications. Biomed Pharmacother 2023; 165:115027. [PMID: 37354812 DOI: 10.1016/j.biopha.2023.115027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023] Open
Abstract
The types of urothelial carcinoma (UC) include urothelial bladder cancer and upper tract urothelial carcinoma. Current diagnostic techniques cannot meet the needs of patients. Liquid biopsy is an accurate method of determining the molecular profile of UC and is a cutting-edge and popular technique that is expected to complement existing detection techniques and benefit patients with UC. Circulating tumor cells, cell-free DNA, cell-free RNA, extracellular vesicles, proteins, and metabolites can be found in the blood, urine, or other bodily fluids and are examined during liquid biopsies. This article focuses on the components of liquid biopsies and their clinical applications in UC. Liquid biopsies have tremendous potential in multiple aspects of precision oncology, from early diagnosis and treatment monitoring to predicting prognoses. They may therefore play an important role in the management of UC and precision medicine.
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Affiliation(s)
- Siyu Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Rong Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yuanhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Jiazheng Yu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Jianyi Zheng
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Zeyu Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Mingyang Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Kerong Xin
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yang Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning 110042, China.
| | - Zhenqun Xu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
| | - Shijie Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
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Koukourikis P, Papaioannou M, Georgopoulos P, Apostolidis I, Pervana S, Apostolidis A. A Study of DNA Methylation of Bladder Cancer Biomarkers in the Urine of Patients with Neurogenic Lower Urinary Tract Dysfunction. BIOLOGY 2023; 12:1126. [PMID: 37627010 PMCID: PMC10452268 DOI: 10.3390/biology12081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Background: Bladder cancer (BCa) in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) is a significant concern due to its advanced stage at diagnosis and high mortality rate. Currently, there is a scarcity of specific guidelines for BCa screening in these patients. The development of urine biomarkers for BCa seems to be an attractive non-invasive method of screening or risk stratification in this patient population. DNA methylation is an epigenetic modification, resulting in the transcriptional silencing of tumor suppression genes, that is frequently detected in the urine of BCa patients. Objectives: We aimed to investigate DNA hypermethylation in five gene promoters, previously associated with BCa, in the urine of NLUTD patients, and in comparison with healthy controls. Design, setting and participants: This was a prospective case-control study that recruited neurourology outpatients from a public teaching hospital who had suffered from NLUTD for at least 5 years. They all underwent cystoscopy combined with biopsy for BCa screening following written informed consent. DNA was extracted and DNA methylation was assessed for the RASSF1, RARβ, DAPK, TERT and APC gene promoters via quantitative methylation-specific PCR in urine specimens from the patients and controls. Results: Forty-one patients of mixed NLUTD etiology and 35 controls were enrolled. DNA was detected in 36 patients' urine specimens and in those of 22 controls. In the urine specimens, DNA was hypermethylated in at least one of five gene promoters in 17/36 patients and in 3/22 controls (47.22% vs. 13.64%, respectively, p = 0.009). RASSF1 was hypermethylated in 10/17 (58.82%) specimens with detected methylation, APC in 7/17 (41.18%), DAPK in 4/17 (23.53%), RAR-β2 in 3/17 (17.56%) and TERT in none. According to a multivariate logistic regression analysis, NLUTD and male gender were significantly associated with hypermethylation (OR = 7.43, p = 0.007 and OR = 4.21; p = 0.04, respectively). In the tissue specimens, histology revealed TaLG BCa in two patients and urothelial squamous metaplasia in five patients. Chronic bladder inflammation was present in 35/41 bladder biopsies. Conclusions: DNA hypermethylation in a panel of five BCa-associated genes in the urine was significantly more frequent in NLUTD patients than in the controls. Our results warrant further evaluation in longitudinal studies assessing the clinical implications and possible associations between DNA hypermethylation, chronic inflammation and BCa in the NLUTD population.
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Affiliation(s)
- Periklis Koukourikis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
| | - Maria Papaioannou
- Department of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Petros Georgopoulos
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
- Pelvic Floor Unit, Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Ioannis Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
| | - Stavroula Pervana
- Department of Pathology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece;
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
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Struck JP, Ozimek T, Schnoor M, Offermann A, Guenther M, Roesch MC, Wießmeye JR, Katalinic A, Perner S, Borgmann H, Merseburger AS, Kramer MW. The Role of Urine and Washing Cytology in Primary Transurethral Resection of Bladder Tumours. Urol Int 2023; 107:792-800. [PMID: 37497994 DOI: 10.1159/000531443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/31/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Urine cytology (UC) is a recommended tool for the diagnosis of urothelial malignancies. Thus far, no specific recommendations regarding the role of washing cytology (WC) have been included in the guidelines. The goal of our study was to analyse the relationship between the histology of transurethrally (transurethral resection of the bladder [TURBT]) resected bladder tumours (BCa) and intraoperative UC or WC findings. MATERIALS AND METHODS Five hundred consecutive primary TURBT cases conducted between November 2010 and 2015 at our department of the University Hospital Luebeck were retrospectively analysed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of UC and WC were evaluated to detect BCa. Multivariate logistic regression models were fit to further examine associations between patient- and tumour-related factors and a bladder UC or WC positive for BCa. RESULTS UC was performed in 297 patients, WC in 294 patients, and both in 261 patients. Sensitivity was 50.7% in UC, 58.1% in WC, and 62.1% for both tests combined. Specificity was 97.8% for UC, 98.0% for WC, and 96.4% for the combined tests. PPV was 98.0% for UC, 98.1% for WC, and 97.2% for combined tests. NPV was 47.8% for UC, 54.5% for WC, and 55.9% for the combined tests. The multivariate analyses revealed no association between positive UC or WC results and subsequent radical cystectomy (UC OR 1.35, 95% CI: 0.3-5.7; WC OR 2.0, 95% CI: 0.4-11.4). Neither UC nor WC was significantly correlated with local recurrence. CONCLUSIONS Cytologic testing is an important diagnostic tool in BCa detection, showing acceptable sensitivity of around 60% and excellent specificity of over 90%. UC and WC present similar sensitivity. Our results advocate, however, against cytologic testing during primary TURBT, especially with regard to the lack of value in assessing the risk of recurrence. The clinical benefit of taking both types of samples at once is minimal. Furthermore, intraoperative WC collection does not reliably predict subsequent cystectomies.
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Affiliation(s)
- Julian P Struck
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tomasz Ozimek
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | - Maike Schnoor
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Luebeck, Germany
| | - Anne Offermann
- Institute of Pathology, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Institute of Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Marlis Guenther
- Institute for Pathology, Medical School Brandenburg, Brandenburg a.d. Havel, Germany
| | - Marie C Roesch
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Judith R Wießmeye
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Alexander Katalinic
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Institute of Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Hendrik Borgmann
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Axel S Merseburger
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Mario W Kramer
- Department of Urology, University-Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Ecke TH, Lotan Y, Massfelder T. Editorial: Identifying novel biomarkers in bladder cancer. Front Oncol 2023; 13:1191736. [PMID: 37469396 PMCID: PMC10353301 DOI: 10.3389/fonc.2023.1191736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, Helios Hospital Bad, Saarow, Germany
- Deparment of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Thierry Massfelder
- INSERM (French National Institute of Health and Medical Research) UMR_S1260, Université de Strasbourg, Regenerative Nanomedicine, Centre de Recherche en Biomédecine de Strasbourg, Strasbourg, France
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Sanya DRA, Onésime D. Roles of non-coding RNAs in the metabolism and pathogenesis of bladder cancer. Hum Cell 2023:10.1007/s13577-023-00915-5. [PMID: 37209205 DOI: 10.1007/s13577-023-00915-5] [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: 01/29/2023] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
Bladder cancer (BC) is featured as the second most common malignancy of the urinary tract worldwide with few treatments leading to high incidence and mortality. It stayed a virtually intractable disease, and efforts to identify innovative and effective therapies are urgently needed. At present, more and more evidence shows the importance of non-coding RNA (ncRNA) for disease-related study, diagnosis, and treatment of diverse types of malignancies. Recent evidence suggests that dysregulated functions of ncRNAs are closely associated with the pathogenesis of numerous cancers including BC. The detailed mechanisms underlying the dysregulated role of ncRNAs in cancer progression are still not fully understood. This review mainly summarizes recent findings on regulatory mechanisms of the ncRNAs, long non-coding RNAs, microRNAs, and circular RNAs, in cancer progression or suppression and focuses on the predictive values of ncRNAs-related signatures in BC clinical outcomes. A deeper understanding of the ncRNA interactive network could be compelling framework for developing biomarker-guided clinical trials.
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Affiliation(s)
- Daniel Ruben Akiola Sanya
- Micalis Institute, Diversité génomique et fonctionnelle des levures, domaine de Vilvert, Université Paris-Saclay, INRAE, AgroParisTech, 78350, Jouy-en-Josas, France.
| | - Djamila Onésime
- Micalis Institute, Diversité génomique et fonctionnelle des levures, domaine de Vilvert, Université Paris-Saclay, INRAE, AgroParisTech, 78350, Jouy-en-Josas, France
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50
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Awad M, Harraz AM, Farg H, Gabr HS, Sharaf DE, Abou-El-Ghar M, El-Hefnawy AS, Osman Y. Microscopic hematuria and pelvic ultrasonography could rule out flexible cystoscopy during surveillance for T1-low grade non-muscle invasive bladder cancer. Arab J Urol 2023; 21:150-155. [PMID: 37521447 PMCID: PMC10373612 DOI: 10.1080/2090598x.2023.2202930] [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: 02/01/2023] [Accepted: 04/09/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE Cystoscopy (rigid/flexible [FC]) is the standard surveillance tool for non-muscle invasive bladder cancer (NMIBC). Nevertheless, it has its drawbacks. The objective of this study is to evaluate the performance of microscopic hematuria (MH), abdominal ultrasonography (US), and urine cytology (UC) as potential substitutes for FC in patients with T1-low-grade (T1-LG) NMIBC. METHODS Over a 12-month period, patients attending our tertiary referral center for T1-LG NMIBC follow-up underwent urine analysis for MH and UC, and then US and FC were performed as outpatient surveillance procedures. Those with positive findings underwent inpatient rigid cystoscopy under anesthesia and biopsy. The negative predictive values (NPV) and sensitivity of different combinations of MH, UC, US, and FC were compared with the standard histopathology. RESULTS In 218 evaluated patients, FC had the highest NPV (97.9%). However, this figure showed no statistically significant difference if compared with the combination of negative MH and US (93.8%) (difference = 0.04, p = 0.1) or the combination of MH, US, and UC (94.9%) (difference = 0.03, p = 0.2). The reported sensitivity results were similarly comparable between FC (94.2%) and the aforementioned combinations (90.4% and 92.3%; differences: 0.038 and 0.019; p = 0.4 and 0.7, respectively). CONCLUSIONS During the surveillance of NMIBC for patients diagnosed with T1-LG disease, the combination of MH/US has comparable sensitivity and NPV with FC. This non-invasive combination could be considered the first station that might preclude the need for FC in a considerable percentage of this group of patients.
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Affiliation(s)
- Mohamed Awad
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Harraz
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hashim Farg
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hady S. Gabr
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Doaa E. Sharaf
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | | | | | - Yasser Osman
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
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