1
|
Levy JJ, Chan N, Marotti JD, Rodrigues NJ, Ismail AAO, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Suriawinata AA, Christensen B, Liu X, Vaickus LJ. Examining longitudinal markers of bladder cancer recurrence through a semiautonomous machine learning system for quantifying specimen atypia from urine cytology. Cancer Cytopathol 2023; 131:561-573. [PMID: 37358142 PMCID: PMC10527805 DOI: 10.1002/cncy.22725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Urine cytology is generally considered the primary approach for screening for recurrence of bladder cancer. However, it is currently unclear how best to use cytological examinations for assessment and early detection of recurrence, beyond identifying a positive finding that requires more invasive methods to confirm recurrence and decide on therapeutic options. Because screening programs are frequent, and can be burdensome, finding quantitative means to reduce this burden for patients, cytopathologists, and urologists is an important endeavor and can improve both the efficiency and reliability of findings. Additionally, identifying ways to risk-stratify patients is crucial for improving quality of life while reducing the risk of future recurrence or progression of the cancer. METHODS In this study, a computational machine learning tool, AutoParis-X, was leveraged to extract imaging features from urine cytology examinations longitudinally to study the predictive potential of urine cytology for assessing recurrence risk. This study examined how the significance of imaging predictors changes over time before and after surgery to determine which predictors and time periods are most relevant for assessing recurrence risk. RESULTS Results indicate that imaging predictors extracted using AutoParis-X can predict recurrence as well or better than traditional cytological/histological assessments alone and that the predictiveness of these features is variable across time, with key differences in overall specimen atypia identified immediately before tumor recurrence. CONCLUSIONS Further research will clarify how computational methods can be effectively used in high-volume screening programs to improve recurrence detection and complement traditional modes of assessment.
Collapse
Affiliation(s)
- Joshua J. Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Natt Chan
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Jonathan D. Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Nathalie J. Rodrigues
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
| | - A. Aziz O. Ismail
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- White River Junction VA Medical Center, White River Junction, VT, 05009
| | - Darcy A. Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Edward J. Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | | | | | - Arief A. Suriawinata
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Brock Christensen
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Community and Family Medicine, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Louis J. Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| |
Collapse
|
2
|
Ecke TH, Benderska-Söder N, Bismarck E, van Rhijn BWG, Todenhöfer T, Schmitz-Dräger BJ. Considering the Effects of Modern Point-of-Care Urine Biomarker Assays in Follow-Up of Patients with High-Risk Non-muscle-Invasive Bladder Cancer. Methods Mol Biol 2023; 2684:199-212. [PMID: 37410236 DOI: 10.1007/978-1-0716-3291-8_12] [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: 07/07/2023]
Abstract
BACKGROUND Although a plethora of urine markers for diagnosis and follow-up of patients with bladder cancer (BC) has been developed and studied, the clinical impact of urine testing on patient management remains unclear. The goal of this manuscript is to identify scenarios for a potential use of modern point-of-care (POC) urine marker assays in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. METHODS To permit comparison between different assays, the results of 5 different POC assays studied in a recent prospective multicenter study including 127 patients with suspicious cystoscopy undergoing TURB were used for this simulation. For the current standard of care (SOC), a "marker-enforced" procedure, and a combined strategy sensitivity (Se), estimated number of cystoscopies, and the numbers needed to diagnose (NND) over a 1-year follow-up period were calculated. RESULTS For regular cystoscopy (SOC), a Se of 91.7% and a NND of 42.2 repetitive office cystoscopies (WLCs) for 1 recurrent tumor at 1 year were calculated. For the "marker-enforced" strategy, marker sensitivities between 94.7% and 97.1% were observed. The "combined" strategy yielded for markers with a Se exceeding 50% an overall Se at 1 year similar or superior to the current SOC. Savings regarding the number of cystoscopies in the "marker-enforced" strategy vs. the SOC were small, while, depending on the marker, up to 45% of all cystoscopies may be saved using the "combined" strategy. CONCLUSIONS Based on the results of this simulation, a marker-supported follow-up of patients with high-risk (HR) NMIBC is safe and offers options to significantly reduce the number of cystoscopies without compromising the Se. Further research focusing on prospective randomized trials is needed to finally find a way to include marker results into clinical decision-making.
Collapse
Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany.
- Department of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany.
- German Study Group of Bladder Cancer (DFBK e.V.), Munich, Germany.
| | | | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Tilman Todenhöfer
- Studienpraxis Urologie, Nürtingen, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nürnberg, Germany
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| |
Collapse
|
3
|
Gao F, Wang J, Yu Y, Yan J, Ding G. Comprehensive optimization of urinary exfoliated tumor cells tests in bladder cancer with a promising microfluidic platform. Cancer Med 2022; 12:7283-7293. [PMID: 36567509 PMCID: PMC10067033 DOI: 10.1002/cam4.5481] [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: 05/03/2022] [Revised: 05/16/2022] [Accepted: 11/14/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enrichment of urinary exfoliated tumor cells (UETCs) is a noninvasive way of bladder cancer diagnosis, but the lack of specific capture and identification of tumor cells from the urine remains a limitation that impedes the development of liquid biopsy. METHODS The CytoBot® 2000, a novel circulating cell isolation and enrichment platform, was used for UETCs isolation after comprehensive optimization. The commercial cell lines of bladder cancer were used in spiking assay for cell recovery test. The flow cytometry and immunofluorescent staining assays were performed for expression validation of capture target and identification markers. The performance of optimized platform was validated by 159 clinical samples and analyzed using receiver operator characteristic curve. RESULTS The chip that had a pore diameter of 15*20 μm could reduce the background residues while maintaining a higher cell recovery rate. We found that the cell capture ability of chip significantly improved after anti-EpCam antibody encapsulation, but not with T4L6FM1. In identification system optimization, the spiking assay and validation of clinical sample showed that the performance of CK20 and DBC-1 were better that pan-CK in tumor cell identification, in addition, the staining quality is more legible with CK20. CONCLUSION The optimized capture chip is more specific for UETCs isolation. CK20 and DBC-1 are both sensitive biomarkers of UETCs in bladder cancer diagnosis. The performance of this optimized platform is excellent in clinical test that improves the accuracy of urine cell testing and provides a new alternative for the clinical application of BLCA liquid biopsy assessment.
Collapse
Affiliation(s)
- Fengbin Gao
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Wang
- Holosensor Medical Ltd., Suzhou, China
| | - Yanlan Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Yan
- Holosensor Medical Ltd., Suzhou, China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
4
|
Lett L, George M, Slater R, De Lacy Costello B, Ratcliffe N, García-Fiñana M, Lazarowicz H, Probert C. Investigation of urinary volatile organic compounds as novel diagnostic and surveillance biomarkers of bladder cancer. Br J Cancer 2022; 127:329-336. [PMID: 35352020 PMCID: PMC9296481 DOI: 10.1038/s41416-022-01785-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The diagnosis and surveillance of urothelial bladder cancer (UBC) require cystoscopy. There is a need for biomarkers to reduce the frequency of cystoscopy in surveillance; urinary volatile organic compound (VOC) analysis could fulfil this role. This cross-sectional study compared the VOC profiles of patients with and without UBC, to investigate metabolomic signatures as biomarkers. METHODS Urine samples were collected from haematuria clinic patients undergoing diagnostic cystoscopy and UBC patients undergoing surveillance. Urinary headspace sampling utilised solid-phase microextraction and VOC analysis applied gas chromatography-mass spectrometry; the output underwent metabolomic analysis. RESULTS The median participant age was 70 years, 66.2% were male. Of the haematuria patients, 21 had a new UBC diagnosis, 125 had no cancer. In the surveillance group, 75 had recurrent UBC, 84 were recurrence-free. A distinctive VOC profile was observed in UBC patients compared with controls. Ten VOCs had statistically significant abundances useful to classify patients (false discovery rate range 1.9 × 10-7-2.8 × 10-2). Two prediction models were evaluated using internal validation. An eight-VOC diagnostic biomarker panel achieved AUROC 0.77 (sensitivity 0.71, specificity 0.72). A six-VOC surveillance biomarker panel obtained AUROC 0.80 (sensitivity 0.71 and specificity 0.80). CONCLUSIONS Urinary VOC analysis could aid the diagnosis and surveillance of UBC.
Collapse
Affiliation(s)
- Lauren Lett
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Michael George
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
- School of Medicine, Cedar House, University of Liverpool, Liverpool, L69 3GE, UK
| | - Rachael Slater
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Ben De Lacy Costello
- Centre of Research in Biosciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, UK
| | - Norman Ratcliffe
- Centre of Research in Biosciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, UK
| | - Marta García-Fiñana
- Department of Health Data Science, University of Liverpool, Liverpool, L69 3GE, UK
| | - Henry Lazarowicz
- Department of Urology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Trust, Liverpool, L7 8XP, UK
| | - Chris Probert
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GE, UK.
| |
Collapse
|
5
|
Nagai T, Naiki T, Etani T, Iida K, Noda Y, Shimizu N, Isobe T, Nozaki S, Okamura T, Ando R, Kawai N, Yasui T. UroVysion fluorescence in situ hybridization in urothelial carcinoma: a narrative review and future perspectives. Transl Androl Urol 2021; 10:1908-1917. [PMID: 33968678 PMCID: PMC8100858 DOI: 10.21037/tau-20-1207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of patients with urothelial carcinoma (UC) is high, with a corresponding demand for detecting UC easily and non-invasively. Cystoscopy and urine cytology, with widely known diagnostic accuracies, are the gold standards for identifying UC originating from the bladder. However, cystoscopy or other tests, such as ureteroscopy or retrograde pyelography, are uncomfortable for patients. Tests for urinary biomarkers are expected to satisfy the demand for less invasive tests that will benefit patients with anxiety for invasive tests such as cystoscopy or ureteroscopy. Although several urinary biomarkers have been reported to support the diagnosis or follow-up of UC, their use in the clinic is uncommon. The UroVysion test examines urinary biomarkers using a multitarget, multicolor fluorescence in situ hybridization (FISH) assay. The test uses exfoliated cells found in urine and is a mixture of centromeric fluorescent denatured chromosome enumeration probes for chromosomes 3, 7, and 17 (labelled stratum red, spectrum green and spectrum aqua, respectively), and a locus-specific identifier probe for 9p21 (spectrum gold). It is used for the initial diagnosis of patients with hematuria or the monitoring of patients previously diagnosed with bladder cancer. Almost 20 years have passed since UroVysion was approved by the U.S. Food and Drug Administration, and so this is a well-established test. However, room exists for further research, with numerous reports on this test having been recently published. In order to update our knowledge, we herein present a brief overview of UroVysion and its features that follows the latest findings as they relate to UC.
Collapse
Affiliation(s)
- Takashi Nagai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiki Etani
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keitaro Iida
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Noda
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuhiko Shimizu
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Teruki Isobe
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Nozaki
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
6
|
Semeniuk-Wojtaś A, Lubas A, Cierniak S, Brzóskowska U, Syryło T, Zieliński H, Stec R. Selected protein expression in a new prognostic model for patients with non-muscle-invasive bladder cancer. J Cancer Res Clin Oncol 2020; 146:2099-2108. [PMID: 32239282 PMCID: PMC7324417 DOI: 10.1007/s00432-020-03202-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION After transurethral resection of a bladder tumor, patients frequently have a recurrence of the disease, thereby requiring adjuvant therapy. PURPOSE The study aimed to determine the prognostic value of expression levels of p53, Ki-67, and survivin, and to develop a new prognostic model for patients with non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of a bladder tumor. METHODS The study group consisted of 101 patients with primary NMIBC. Univariate followed by multivariate Cox proportional hazard regression analysis was performed to obtain a model including the smallest possible number of descriptive variables with the highest statistical significance and impact on risk. RESULTS The RECINT model (RECurrence In Not Treated) including factors independently associated with cancer recurrence (tumor size [HR 1.148; p = 0.034], intensity of the color reaction for p53 [HR 1.716; p = 0.008], Ki-67 [HR 3.001; p = 0.022], and survivin [HR 1.461; p = 0.021]) adequately stratified recurrence free-survival (R2 = 0.341, p < 0.001) in patients with primary NMIBC. Patients with the lowest RECINT score (0-6) had the lowest probability of cancer recurrence (1- and 5-year recurrence of 16%) in comparison with other groups (p < 0.001). CONCLUSIONS The RECINT model may be useful for stratifying the risk of recurrence in patients with non-muscle-invasive bladder cancer and may allow for identification of those who may benefit the most from adjuvant BCG immunotherapy.
Collapse
Affiliation(s)
| | - Arkadiusz Lubas
- Internal Diseases, Nephrology and Dialysis Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Szczepan Cierniak
- Patomorphology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Urszula Brzóskowska
- Patomorphology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Tomasz Syryło
- General, Functional and Oncological Urology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Henryk Zieliński
- General, Functional and Oncological Urology Department, Military Institute of Medicine, 128 Szaserów St., 04-141, Warsaw, Poland
| | - Rafał Stec
- Oncology Department, Medical University of Warsaw, 19/25 Stępińska St., 00-739, Warsaw, Poland
| |
Collapse
|
7
|
Benderska-Söder N, Hovanec J, Pesch B, Goebell PJ, Roghmann F, Noldus J, Rabinovich J, Wichert K, Gleichenhagen J, Käfferlein HU, Köhler CU, Johnen G, Kernig K, Hakenberg O, Jahn D, Todenhöfer T, Stenzl A, Gleissner J, Gerwert K, El-Mashtoly S, Behrens T, Brüning T, Schmitz-Dräger BJ. Toward noninvasive follow-up of low-risk bladder cancer - Rationale and concept of the UroFollow trial. Urol Oncol 2020; 38:886-895. [PMID: 32199755 DOI: 10.1016/j.urolonc.2020.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Follow-up recommendations for patients with nonmuscle invasive bladder cancer (NMIBC) are largely based upon expert opinion. A growing body of evidence suggests that current follow-up strategies for bladder cancer patients with low and intermediate risk represent overdiagnosis and may lead to overtreatment. The goal of this study is to explore the options of a noninvasive follow-up in patients with pTa G1-2/low-grade NMIBC. METHODS The risks and options for a urine marker-guided, noninvasive follow-up of patients with pTa G1-2/low-grade NMIBC were defined and the study design for a prospective randomized trial (UroFollow) was developed based upon the current literature. RESULTS The investigators postulated that follow-up of patients with pTa G1-2/low-grade NMIBC requires a high sensitivity of urinary tumor markers. However, data from prospective studies with prediagnostic urine samples are scarce, even for approved markers, and cross-sectional studies with symptomatic patients overestimate the sensitivity. So far, cell-based markers (e.g., uCyt+ and UroVysion) in urine appeared to have higher sensitivities and specificities in low-grade NMIBC than urine cytology and markers analyzing soluble tumor-associated antigens. Marker panels are more sensitive than single-marker approaches at the expense of a lower specificity. Given a prospective randomized comparison with a marker sensitivity of 80% compared to usual care with cystoscopy, the sample size calculation yielded that 62 to 185 patients under study per arm are needed depending on different recurrence rates. CONCLUSIONS Based upon these findings the UroFollow trial has been designed as a prospective randomized study comparing a noninvasive marker-based (UroVysion, NMP22, urine cytology, and ultrasound) follow-up with the current standard of care over a period of 3 years.
Collapse
Affiliation(s)
| | - Jan Hovanec
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | | | - Katharina Wichert
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Jan Gleichenhagen
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Heiko U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Christina U Köhler
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Karoline Kernig
- Department of Urology, University of Rostock, Rostock, Germany
| | | | - Daniela Jahn
- Department of Urology, University of Rostock, Rostock, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | | | - Klaus Gerwert
- Ruhr University Bochum, Faculty of Biology and Biotechnology, Department of Biophysics, Bochum, Germany; Ruhr University Bochum, Center for Protein Diagnostics (ProDi), Biospectroscopy, Bochum, Germany
| | - Samir El-Mashtoly
- Ruhr University Bochum, Faculty of Biology and Biotechnology, Department of Biophysics, Bochum, Germany; Ruhr University Bochum, Center for Protein Diagnostics (ProDi), Biospectroscopy, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nürnberg, Germany; Department of Urology, Friedrich-Alexander University, Erlangen, Germany.
| |
Collapse
|
8
|
Agreda Castañeda F, Raventós Busquets C, Morote Robles J. Urinary markers in the surveillance of non-muscle invasive bladder cancer. A literature review. Actas Urol Esp 2019; 43:404-413. [PMID: 31097210 DOI: 10.1016/j.acuro.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The surveillance of non-muscle-invasive bladder cancer (NMIBC) is usually performed by cystoscopy and cytology. Until today, no effective urinary biomarker has been used to reduce the morbidity and cost associated with these procedures. OBJECTIVE To describe the performance of urinary biomarkers in the surveillance of NMIBC. EVIDENCE ACQUISITION on August 1, 2018, a bibliographic search was carried out in Pubmed, Embase and Cochrane Library, limited to the last 10 years, with the terms: bladder cancer, recurrence, detection and urine marker.973 registers were obtained, and 27 publications were selected following the PRISMA recommendations. EVIDENCE SYNTHESIS The negative predictive values (NPV) of several assays could reduce the number of cystoscopies in NMIBC surveillance. Six transcription-factor trials had an NPV rate greater than 90%, and one of them can be performed at the control point. Six transcription-factors evaluations describe anticipated diagnosis between 68% and 83% of their "false positives". Two transcription factors and one protein assays proved reduction between 23% and 35% of surveillance cystoscopies. Nowadays, cell-based assays are restricted to reflex test after doubtful cytologies. CONCLUSION There are few studies analysing the improvement of the NMIBC surveillance protocols. Several transcription factor assays are more precise and allow anticipatory diagnosis. Currently, there are no comparative studies between alternative surveillance protocols and classic ones.
Collapse
|
9
|
Liang Q, Zhang G, Li W, Wang J, Sheng S. Comparison of the diagnostic performance of fluorescence in situ hybridization (FISH), nuclear matrix protein 22 (NMP22), and their combination model in bladder carcinoma detection: a systematic review and meta-analysis. Onco Targets Ther 2018; 12:349-358. [PMID: 30643432 PMCID: PMC6317485 DOI: 10.2147/ott.s186065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Emerging studies reported that combination of fluorescence in situ hybridization (FISH) and nuclear matrix protein 22 (NMP22) could increase the sensitivity and specificity of bladder carcinoma (BC) management. Nevertheless, the reports remain inconsistent. This meta-analysis was undertaken to evaluate the diagnostic performance of FISH, NMP22, and their combination model in BC. Materials and methods A systematic literature search was carried out in PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang database dated up to October 2018. Suitable studies were identified and raw data were extracted. Meta-analysis was conducted to calculate the global sensitivities, specificities, likelihood ratio, diagnostic odds ratio (DOR), and the areas under the summary receiver operating characteristic (SROC) curves for FISH, NMP22, and their combination model, separately. All the meta-analysis estimates were derived using STATA (version 12.0) and MetaDisc (version 1.4) software packages. Results Seven eligible studies were included for analysis. The global sensitivities with 95% CI for FISH, NMP22, and their combination model were 0.79 (95% CI: 0.75–0.83), 0.76 (95% CI: 0.71–0.81), and 0.82 (95% CI: 0.75–0.88); specificities were 0.85 (95% CI: 0.76–0.91), 0.70 (95% CI: 0.55–0.81), and 0.90 (95% CI: 0.70–0.97); DORs were 22.215 (95% CI: 10.695–46.144), 7.365 (95% CI: 3.986–13.610), and 41.940 (95% CI: 13.546–129.853); and the areas under the SROC curves were 0.86 (95% CI: 0.82–0.88), 0.79 (95% CI: 0.76–0.83), and 0.90 (95% CI: 0.87–0.92). Conclusion Our systematic review implied that the diagnostic performance of combination model of FISH plus NMP22 may outperform FISH or NMP22 alone in BC detection.
Collapse
Affiliation(s)
- Qindong Liang
- Department of Clinical Laboratory, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China,
| | - Guangjie Zhang
- Department of Clinical Laboratory, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Wuxian Li
- Department of Clinical Laboratory, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jing Wang
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shangchun Sheng
- Department of Clinical Laboratory, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China,
| |
Collapse
|
10
|
Abstract
Purpose Use of molecular markers in urine, tissue or blood offers potential opportunities to improve understanding of bladder cancer biology which may help identify disease earlier, risk stratify patients, improve prediction of outcomes or help target therapy. Methods A review of the published literature was performed, without restriction of time. Results Despite the fast-growing literature about the topic and the approval of several urinary biomarkers for use in clinical practice, they have not reached the level of evidence for widespread utilization. Biomarkers could be used in different clinical scenarios, mainly to overcome the limitations of current diagnostic, predictive, and prognostic tools. They have been evaluated to detect bladder cancer in asymptomatic populations or those with hematuria and in surveillance of disease as adjuncts to cystoscopy. There is also a potential role as prognosticators of disease recurrence, progression and survival both in patients with non-invasive cancers and in those with advanced disease. Finally, they promise to be helpful in predicting the response to local and/or systemic chemotherapy and/or immunotherapy. Conclusions To date, due to the lack of high-quality prospective trials, the level of evidence provided by the current literature remains low and, therefore, the potential of biomarkers exceeds utilization in clinical practice.
Collapse
|
11
|
Rosolen DCB, Faria DK, Faria CS, Antonangelo L. Performance of the UroVysion ® FISH assay for the diagnosis of malignant effusions using two cutoff strategies. Cancer Med 2018; 7:1967-1977. [PMID: 29577646 PMCID: PMC5943432 DOI: 10.1002/cam4.1442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/09/2018] [Accepted: 02/17/2018] [Indexed: 12/27/2022] Open
Abstract
The cytological examination of cavity fluids has limited sensitivity in the diagnosis of malignancy. Aneuploidy, which is commonly observed in neoplastic cells, could potentially be used as an ancillary diagnostic tool. To evaluate the detection of aneuploid cells in cavitary effusion samples using the fluorescence in situ hybridization (FISH) assay UroVysion® with some adaptations and two different cutoff strategies. Seventy samples of pleural or peritoneal fluid with positive (n = 40), negative (n = 15), or suspicious (n = 15) oncotic cytology were subjected to FISH assay with the multitarget UroVysion® kit, which is composed of probes that hybridize to the centromeric region of chromosomes 3, 7, and 17 and to the locus 9p21. FISH performance was evaluated using two different cutoffs: (1) the manufacturer's cutoff (M‐FISH) and 2) a proposed cutoff (P‐FISH). Using M‐FISH, the diagnostic sensitivity was 57.1%, specificity 87.5%, and accuracy 60.0%; with P‐FISH, the sensitivity was 87.3%, specificity 71.4%, and accuracy 85.7%. When combined with cytology, the sensitivity, specificity, and accuracy were 88.0%, 83.3%, and 87.8%, respectively. Malignant cells presented a predominance of chromosomal gains. The UroVysion® test using the P‐FISH cutoff was effective in demonstrating aneuploid cells in all malignant effusions, confirming the diagnosis of malignancy even in cases with suspicious cytology.
Collapse
Affiliation(s)
- Débora C B Rosolen
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel K Faria
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caroline S Faria
- Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leila Antonangelo
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
12
|
Sanli O, Lotan Y. Current approaches for identifying high-risk non-muscle invasive bladder cancer. Expert Rev Anticancer Ther 2018; 18:223-235. [DOI: 10.1080/14737140.2018.1432358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Oner Sanli
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
13
|
Performance of Urinary Markers for Detection of Upper Tract Urothelial Carcinoma: Is Upper Tract Urine More Accurate than Urine from the Bladder? DISEASE MARKERS 2018; 2018:5823870. [PMID: 29651327 PMCID: PMC5831978 DOI: 10.1155/2018/5823870] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022]
Abstract
Objectives To assess the performance of urine markers determined in urine samples from the bladder compared to samples collected from the upper urinary tract (UUT) for diagnosis of UUT urothelial carcinoma (UC). Patients and Methods The study comprised 758 urine samples either collected from the bladder (n = 373) or UUT (n = 385). All patients underwent urethrocystoscopy and UUT imaging or ureterorenoscopy. Cytology, fluorescence in situ hybridization (FISH), immunocytology (uCyt+), and nuclear matrix protein 22 (NMP22) were performed. Results UUT UC was diagnosed in 59 patients (19.1%) (UUT urine) and 27 patients (7.2%) (bladder-derived urine). For UUT-derived samples, sensitivities for cytology, FISH, NMP22, and uCyt+ were 74.6, 79.0, 100.0, and 100.0, while specificities were 66.6, 50.7, 5.9, and 66.7%, respectively. In bladder-derived samples, sensitivities were 59.3, 52.9, 62.5, and 50.0% whereas specificities were 82.9, 85.0, 31.3, and 69.8%. In UUT-derived samples, concomitant bladder cancer led to increased false-positive rates of cytology and FISH. Conclusions Urine markers determined in urine collected from the UUT exhibit better sensitivity but lower specificity compared to markers determined in bladder-derived urine. Concomitant or recent diagnosis of UC of the bladder can further influence markers determined in UUT urine.
Collapse
|
14
|
Kassouf W, Traboulsi SL, Schmitz-Dräger B, Palou J, Witjes JA, van Rhijn BWG, Grossman HB, Kiemeney LA, Goebell PJ, Kamat AM. Follow-up in non-muscle-invasive bladder cancer-International Bladder Cancer Network recommendations. Urol Oncol 2016; 34:460-8. [PMID: 27368880 DOI: 10.1016/j.urolonc.2016.05.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Non-muscle-invasive bladder cancer (NMIBC) comprises a wide spectrum of tumors with different behaviors and prognoses. It follows that the surveillance for these tumors should be adapted according to the risks of recurrence and progression and should be dynamic in design. METHODS AND MATERIALS Medline search was conducted from 1980 to 2016 using a combination of MeSH and keyword terms. The highest available evidence was reviewed to define different risk groups in NMIBC. The performance of different follow-up tools such as urine cytology, cystoscopy, and upper tract imaging in detecting bladder carcinoma was assessed. Different commercially available urinary markers were investigated to determine whether such markers would contribute to the surveillance of patients with NMIBC. A follow-up scheme based on the early evidence is proposed. RESULTS A risk-based approach is paramount. Cystoscopy and cytology are recommended to be done at 3 months following transurethral resection of bladder tumor. For low-risk tumors, annual cystoscopy alone is sufficient; no upper tract evaluations or cytology is needed except at diagnosis. High-risk tumors should be followed up with a more intense schedule: cystoscopy every 3 months for 2 years, 6 months for 2 years, and then annually, with cytology at frequent intervals, and imaging for upper tract evaluation at 1 year and then every 2 years. Intermediate-risk tumors should be subclassified as per the International Bladder Cancer Group recommendations and when associated with 3 or more of the following findings (multiple tumors, size≥3cm, early recurrence<1 year, frequent recurrences>1 per year) then a surveillance strategy similar to that of high risk should be followed. Several urine markers were more sensitive than cytology in the detection of NMIBC; however, these tests are still costly, require specialized laboratories, and do not replace cystoscopy. Until better and cheaper markers are available, their routine use has not been integrated in the follow-up recommendation of current guidelines. CONCLUSIONS Surveillance of NMIBC should follow a risk-adapted approach, with a combination of cystoscopy, cytology, and upper tract imaging. The aim of this approach is to minimize the therapeutic burden of a disease with high recurrence rates without missing progressing tumors. When designing a diagnostic pathway, first-line diagnostic imaging tests should have high sensitivity to ensure disease positives are included in the test population for further investigation. Second-line investigations should be highly specific, to ensure false-positives are minimized.
Collapse
Affiliation(s)
- Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, Canada.
| | - Samer L Traboulsi
- Department of Urology, McGill University Health Centre, Montreal, Canada
| | | | - Joan Palou
- Servicio de Urología, Fundación Puigvert, Barcelona, Spain
| | - Johannes Alfred Witjes
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J Goebell
- Department of Urology, University Clinic Erlangen, Erlangen, Germany
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
15
|
Urine Cell-Free DNA Integrity Analysis for Early Detection of Prostate Cancer Patients. DISEASE MARKERS 2015; 2015:574120. [PMID: 26412928 PMCID: PMC4564597 DOI: 10.1155/2015/574120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 01/05/2023]
Abstract
Introduction. The detection of tumor-specific markers in urine has paved the way for new early noninvasive diagnostic approaches for prostate cancer. We evaluated the DNA integrity in urine supernatant to verify its capacity to discriminate between prostate cancer and benign diseases of the urogenital tract. Patients and Methods. A total of 131 individuals were enrolled: 67 prostate cancer patients and 64 patients with benign diseases of the urogenital tract (control group). Prostate-specific antigen (PSA) levels were determined. Urine cell-free (UCF) DNA was isolated and sequences longer than 250 bp corresponding to 3 genes (c-MYC, HER2, and AR) were quantified by Real-Time PCR to assess UCF-DNA integrity. Results. UCF-DNA was quantifiable in all samples, while UCF-DNA integrity was evaluable in all but 16 samples. Receiver operating characteristic analysis showed an area under the curve of 0.5048 for UCF-DNA integrity and 0.8423 for PSA. Sensitivity was 0.58 and 0.95 for UCF-DNA integrity and PSA, respectively. Specificity was 0.44 and 0.69, respectively. Conclusions. UCF-DNA integrity showed lower accuracy than PSA and would not seem to be a reliable marker for early prostate cancer diagnosis. Despite this, we believe that UCF-DNA could represent a source of other biomarkers and could detect gene alterations.
Collapse
|