1
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
2
|
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] [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.
Collapse
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
| |
Collapse
|
3
|
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: 12] [Impact Index Per Article: 12.0] [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.
Collapse
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.
| |
Collapse
|
4
|
La Maestra S, Benvenuti M, D'Agostini F, Micale RT. Comet-FISH analysis of urothelial cells. A screening opportunity for bladder cancer? Expert Rev Mol Diagn 2023; 23:653-663. [PMID: 37334662 DOI: 10.1080/14737159.2023.2227381] [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: 04/18/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Bladder cancer (BCa) is the most frequent cancer of the urinary tract, with more than 500,000 reported cases and nearly 200,000 related deaths yearly. Cystoscopy is the standard examination used for the initial diagnosis and follow-up of BCa in the noninvasive stage. However, the American Cancer Society does not include BCa screening in its list of recommended cancer screenings. AREAS COVERED Recently, several urine-based bladder tumor markers (UBBTMs) that identify genomic, transcriptomic, epigenetic, or protein alterations have been introduced, some of which have been approved by the Food and Drug Administration (FDA) to improve its diagnosis and surveillance. Several biomarkers have been found in the tissues and blood of individuals with BCa or predisposed to develop the disease, further enriching our information. EXPERT OPINION From a prevention perspective, alkaline Comet-FISH could be a valuable tool with broad potential for clinical application. Furthermore, a comet assay could be more beneficial for diagnosing and monitoring bladder cancer and determining individual susceptibility. Thus, we recommend further studies to understand the potential of this combined assay in the general population as a potential screening test and in patients initiated into the diagnostic process.
Collapse
Affiliation(s)
| | - Mirko Benvenuti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Rosanna T Micale
- Regione Liguria, Department of Health and Social Services, Genoa, Italy
| |
Collapse
|
5
|
Mullapudi SS, Rahmat JN, Mahendran R, Lim YK, Ong LT, Wong KY, Chiong E, Kang ET, Neoh KG. Tumor-targeting albumin nanoparticles as an efficacious drug delivery system and potential diagnostic tool in non-muscle-invasive bladder cancer therapy. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 46:102600. [PMID: 36064034 DOI: 10.1016/j.nano.2022.102600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Current intravesical chemotherapy for non-muscle invasive bladder cancer (NMIBC) has limited efficacy due to loss of the instilled agent from urine voiding and the agent's lack of specificity for the tumors. We developed a nanocarrier (txCD47-HNP, ∼100 nm) based on human serum albumin conjugated with a peptide that targets the cluster of differentiation 47 receptor overexpressed on bladder cancer (BC) cells. The IC50 of gemcitabine elaidate (GEM) loaded in the txCD47-HNP was almost an order of magnitude lower than that of free GEM. In a mouse orthotopic BC model, GEM loaded in txCD47-HNP effectively reduced the tumor burden. Tumor cells in BC patients' urine can also be targeted by fluorescence-labeled txCD47-HNP resulting in >83 % of the cells exhibiting fluorescence. Thus, txCD47-HNP can potentially be a theranostic agent in NMIBC management by serving as a targeted drug delivery vehicle as well as an alternative to urine cytology.
Collapse
Affiliation(s)
- Sneha Sree Mullapudi
- Department of Biomedical Engineering, National University of Singapore, Kent Ridge 117583, Singapore
| | - Juwita Norasmara Rahmat
- Department of Biomedical Engineering, National University of Singapore, Kent Ridge 117583, Singapore
| | - Ratha Mahendran
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Yew Koon Lim
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Lee Ting Ong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Kah Ying Wong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Edmund Chiong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore; Department of Urology, National University Hospital, Kent Ridge 119074, Singapore
| | - En-Tang Kang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge 117585, Singapore
| | - Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge 117585, Singapore.
| |
Collapse
|
6
|
Allison DB, Zhang ML, Vohra P, VandenBussche CJ. The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens. Diagnostics (Basel) 2022; 12:diagnostics12040931. [PMID: 35453979 PMCID: PMC9025489 DOI: 10.3390/diagnostics12040931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Since the release of The Paris System for Reporting Urinary Cytology (TPS), the assessment of urine cytology specimens has primarily focused on the detection of high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). Fortunately, the malignant cells in these lesions tend to be loosely cohesive, resulting in the natural exfoliation of individual malignant cells into the urine. However, HGUC/CIS lesions occasionally exfoliate larger fragments which can be difficult to assess due to cellular overlap and fragment three-dimensionality. Furthermore, reactive benign urothelial fragments and fragments from low-grade urothelial neoplasms (LGUN) may also be seen in urine specimens and contain atypical cytomorphologic features. As a result, the significance of urothelial tissue fragments (UTFs) is often unclear. Herein, we discuss the literature on UTFs before and after the implementation of TPS, as well as strategies to help overcome this diagnostic challenge.
Collapse
Affiliation(s)
- Derek B. Allison
- Department of Pathology and Laboratory Medicine, Lexington, KY 40536, USA;
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Poonam Vohra
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Christopher J. VandenBussche
- Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-955-1180
| |
Collapse
|
7
|
Liu D, Wang S, Wang J. The effect of CT high-resolution imaging diagnosis based on deep residual network on the pathology of bladder cancer classification and staging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 215:106635. [PMID: 35063711 DOI: 10.1016/j.cmpb.2022.106635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE To study the high-resolution CT image based on deep residual network to efficiently and accurately predict the staging diagnosis of bladder tumors. METHODS The image was processed with super-resolution to restore the missing details of the image. The CT data of 75 bladder patients who were treated in our hospital from June to December 2013 were collected. And obtain the patient's classification and staging information through pathology, which is used to establish a model of ResNet structure combined with non-Local attention mechanism. The clinical data of 76 patients with bladder disease admitted to our hospital from May 2018 to August 2021 were randomly selected, and the imaging and accuracy of CT diagnosis were retrospectively analyzed. RESULTS 52 cases were diagnosed <T1 stage, 16 cases belonged to T2 stage, 2 cases T3 stage, and 2 cases T4 stage. The sensitivity rate of experimental diagnosis was 94.74%, which was not significantly different from the sensitivity rate of preoperative pathological diagnosis. CONCLUSION CT based on deep residual network has high application value in the diagnosis and staging of bladder cancer, can effectively improve the diagnostic accuracy, and is worthy of clinical application.
Collapse
Affiliation(s)
- Dongmei Liu
- Department of Urology Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004 China
| | - Shubao Wang
- Department of Pathology Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004 China
| | - Jing Wang
- Department of General Surgery Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004 China.
| |
Collapse
|
8
|
Diagnostische und prädiktive Marker in der Harntraktzytologie. DER PATHOLOGE 2022; 43:99-104. [PMID: 35133495 PMCID: PMC8888376 DOI: 10.1007/s00292-022-01053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 11/20/2022]
Abstract
In der Routinediagnostik spielt die Mehrfach-Fluoreszenz-in-situ-Hybridisierung (FISH) nach wie vor die führende Rolle in der Abklärung unklarer Atypien in der Harntraktzytologie. Die Paris-Klassifikation (The Paris System, TPS) bildet eine wichtige Grundlage zur gezielten Indikationsstellung der FISH und untermauert die Bedeutung der morphologischen Korrelation für eine integrative Diagnosestellung. Die Next-Generation-Sequencing-Technologie, welche durch gleichzeitigen Nachweis multipler genetischer Alterationen eine hohe Sensitivität erzielt, wird in naher Zukunft auch in der Harntraktzytologie Anwendung finden.
Collapse
|
9
|
Nikas IP, Seide S, Proctor T, Kleinaki Z, Kleinaki M, Reynolds JP. The Paris System for Reporting Urinary Cytology: A Meta-Analysis. J Pers Med 2022; 12:jpm12020170. [PMID: 35207658 PMCID: PMC8874476 DOI: 10.3390/jpm12020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.
Collapse
Affiliation(s)
- Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Correspondence:
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Internal Medicine Department, General Hospital of Nikea, 18454 Athens, Greece
| | - Maria Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32256, USA;
| |
Collapse
|
10
|
Crocetto F, Barone B, Ferro M, Busetto GM, La Civita E, Buonerba C, Di Lorenzo G, Terracciano D, Schalken JA. Liquid biopsy in bladder cancer: State of the art and future perspectives. Crit Rev Oncol Hematol 2022; 170:103577. [PMID: 34999017 DOI: 10.1016/j.critrevonc.2022.103577] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023] Open
Abstract
Bladder cancer is the most common malignancy of the urinary tract. Cystoscopy represents the gold standard in the diagnosis of suspicious bladder lesions. However, the procedure is invasive and burdened by pain, discomfort and infective complications. Cytology, which represents an alternative diagnostic possibility is limited by poor sensitivity. Considering the limitations of both procedures, and the necessity to perform multiple evaluations in patients who are in follow-up for bladder cancer, an improved non-invasive methodology is required in the clinical management of this disease. Liquid biopsy, e.g. the detection of clinical biomarkers in urine, represent a promising novel and non-invasive approach that could overcome those limitations and be integrated into the current clinical practice. The aim of this review is to summarize the state of the art of this approach and the latest novelties regarding detection, prognosis and surveillance of bladder cancer.
Collapse
Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carlo Buonerba
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
11
|
Allison DB, Kates M, VandenBussche CJ. Indeterminate atypia in urinary tract cytology: Does it really matter? Diagn Cytopathol 2021; 50:176-183. [PMID: 34870896 DOI: 10.1002/dc.24912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
The study of atypia in urinary cytology has been ongoing for decades but most studies have focused primarily on test performance in patients with concurrent biopsies and/or limited follow-up periods. While these data are useful, many studies fail to consider patient factors that may alter the pretest probability, which can subsequently affect test performance. An isolated diagnosis of malignancy in urinary cytology usually has a high positive predictive value and allows a urologist to conduct a rigorous workup of the patient to establish a tissue diagnosis. However, it is less certain how an atypical diagnosis impacts patient care, given that many patients have a history of bladder cancer and are already under surveillance with cystoscopy at regular screening intervals. Furthermore, a discrete negative urine cytology is unlikely to allow a patient to forego a cystoscopy procedure due to limitations in the sensitivity of urine cytology. Over the last several years, the introduction of The Paris System for Reporting Urinary Cytology (TPS) has improved the predictive value of atypical diagnoses, but additional studies are needed to evaluate the performance of these diagnoses in specific clinical situations. Such data could better inform urologists on how to manage patients with atypical diagnoses. This review discussed the diagnosis of atypia in urinary cytology and the impact of such a diagnosis in various clinical contexts.
Collapse
Affiliation(s)
- Derek B Allison
- Department of Pathology and Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Max Kates
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Sugeeta SS, Sharma A, Ng K, Nayak A, Vasdev N. Biomarkers in Bladder Cancer Surveillance. Front Surg 2021; 8:735868. [PMID: 34651010 PMCID: PMC8506024 DOI: 10.3389/fsurg.2021.735868] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/25/2021] [Indexed: 01/15/2023] Open
Abstract
Aim: This is a narrative review with an aim to summarise and describe urinary biomarkers in the surveillance of non-muscle-invasive bladder cancer (NMIBC). It provides a summary of FDA-approved protein biomarkers along with emerging ones which utilise genetic, epigenetic and exosomal markers. We discuss the current limitations of the available assays. Background: Current guidelines advice a combination of cystoscopy, imaging,and urine cytology in diagnosis and surveillance. Although cytology has a high specificity, it is limited by low sensitivity particularly in low grade tumours. There are six FDA-approved urinary assays for diagnosis and surveillance of bladder cancer. They have shown to improve sensitivity and specificity to be used alongside cytology and cystoscopy but have a lower specificity in comparison to cytology and false positives often occur in benign conditions. Recent developments in laboratory techniques has allowed for use of markers which are RNA-, DNA-based as well as extracellular vesicles in the past decade. Methods: Using the PubMed/Medline search engines as well as Google Scholar, we performed an online search using the terms "bladder cancer," "non-muscle invasive bladder cancer," and "urine biomarkers" with filter for articles in English published up to May 2021. Systematic reviews and original data of clinical trials or observational studies which contributed to the development of the biomarkers were collated. Results: Biomarkers identified were divided into FDA-approved molecular biomarkers, protein biomarkers and gene-related biomarker with a table summarising the findings of each marker with the most relevant studies. The studies conducted were mainly retrospective. Due to the early stages of development, only a few prospective studies have been done for more recently developed biomarkers and limited meta-analyses are available.Therefore a detailed evaluation of these markers are still required to decide on their clinical use. Conclusion: Advancements of analytical methods in BC has driven the research towards non-invasive liquid-based biomarkers in adjunct to urine cytology. Further large prospective studies are required to determine its feasibility in a clinical setting as they are not effective when used in isolation as they have their limitation. With the ongoing pandemic, other than reduction in costs and increased accuracy, the need for biomarkers to cope with delay in cystoscopies in diagnosis and surveillance is crucial. Thus clinical trials with direct comparison is required to improve patient care.
Collapse
Affiliation(s)
- Sukumar S. Sugeeta
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Kenrick Ng
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Arvind Nayak
- Department of Urology and Surgery, Lister Hospital, East and North Herts NHS Trust, Stevenage, United Kingdom
| | - Nikhil Vasdev
- Department of Urology and Surgery, Lister Hospital, East and North Herts NHS Trust, Stevenage, United Kingdom
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| |
Collapse
|
13
|
Piao XM, Kang H, Kim WJ, Yun SJ. Prominence of urinary biomarkers for bladder cancer in the COVID-19 era: From the commercially available to new prospective candidates. Investig Clin Urol 2021; 62:500-519. [PMID: 34488250 PMCID: PMC8421991 DOI: 10.4111/icu.20210194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 12/21/2022] Open
Abstract
Molecular markers detected in urine may improve our understanding of the evolution of bladder cancer (BCa) and its micro- and macroenvironment. Detection of such markers will identify disease earlier, allow stratification of patients according to risk, and improve prognostication and prediction of outcomes, thereby facilitating targeted therapy. However, current guidelines have yet to embrace such markers for routine management of BCa, and most research studies have focused on urine-based tumor markers. In this review, we summarize known urinary biomarkers for BCa and highlight newly identified molecules. We then discuss the challenges that must be overcome to incorporate these markers into clinical care.
Collapse
Affiliation(s)
- Xuan-Mei Piao
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Howon Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
- Institute of Urotech, Cheongju, Korea
| | - Seok Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
- Department of Urology, Chungbuk National University Hospital, Cheongju, Korea.
| |
Collapse
|
14
|
Hupe MC, Hempel MC, Rodler S, Frantzi M, Mischak H, Merseburger AS, Stief CG, Chaloupka M. [Diagnostic markers in urology]. Urologe A 2021; 60:1323-1330. [PMID: 34156515 DOI: 10.1007/s00120-021-01568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cancer diagnostics can be supplemented by disease-related biomarkers. In the course of modern patient-tailored cancer treatment, the importance of correct risk stratification, prognosis and monitoring has significantly increased. In recent years, a multitude of biomarkers and related test procedures have emerged to fulfil this purpose. The following review article summarizes the most recent developments with respect to the use of biomarkers in the diagnostics of urological cancers.
Collapse
Affiliation(s)
- Marie C Hupe
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23638, Lübeck, Deutschland.
| | - Marie C Hempel
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23638, Lübeck, Deutschland
| | - Severin Rodler
- Urologische Klinik und Poliklinik des Klinikums der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - Maria Frantzi
- Abteilung für Biomarkerforschung, Mosaiques Diagnostics GmbH, Hannover, Deutschland
| | - Harald Mischak
- Abteilung für Biomarkerforschung, Mosaiques Diagnostics GmbH, Hannover, Deutschland.,British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Großbritannien
| | - Axel S Merseburger
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23638, Lübeck, Deutschland
| | - Christian G Stief
- Urologische Klinik und Poliklinik des Klinikums der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
| | - Michael Chaloupka
- Urologische Klinik und Poliklinik des Klinikums der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland.
| |
Collapse
|
15
|
Henning GM, Barashi NS, Smith ZL. Advances in Biomarkers for Detection, Surveillance, and Prognosis of Bladder Cancer. Clin Genitourin Cancer 2021; 19:194-198. [PMID: 33781702 DOI: 10.1016/j.clgc.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/26/2020] [Indexed: 02/07/2023]
Abstract
Bladder cancer may present management challenges, as it frequently recurs and can progress when not expeditiously diagnosed and carefully monitored following initial therapy for noninvasive disease. Cystoscopy and cytology have long been the primary tools for the urologist treating bladder cancer. However, as a host of potential biomarkers have been developed, new avenues for noninvasive testing have become available in the detection, surveillance, and prognostic setting. Analysis of urine for mutational signatures at the genetic and epigenetic levels appears promising, but such testing has yet to become widely adopted into clinical practice. Here, we review recent advances in bladder cancer biomarker assays, with particular attention to clinical relevance and potential application.
Collapse
Affiliation(s)
- Grant M Henning
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Nimrod S Barashi
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Zachary L Smith
- Division of Urology, Washington University School of Medicine, St Louis, MO.
| |
Collapse
|
16
|
Hong M, He G, Goh S, Low AWX, Tay KJ, Lim TKH, Yeong J, Khor LY, Lim TS. Biomarkers for Precision Urothelial Carcinoma Diagnosis: Current Approaches and the Application of Single-Cell Technologies. Cancers (Basel) 2021; 13:cancers13020260. [PMID: 33445605 PMCID: PMC7827267 DOI: 10.3390/cancers13020260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Urothelial carcinoma (UC) is the most frequently diagnosed cancer of the urinary tract and is ranked the sixth most diagnosed cancer in men worldwide. About 70–75% of newly diagnosed UCs are non-invasive or low grade. Different tests such as urine cytology and cystoscopy are used to detect UC. If abnormal tissue is found during cystoscopy, then a biopsy will be performed. Cytology has low sensitivity for low-grade cancer while cystoscopy is invasive and costly. Detecting UC early improves the chances of treatment success. Therefore, many researchers have painstakingly identified urine biological markers for non-invasive UC diagnosis. In this review, we summarize some of the latest and most promising biological markers (including FDA-approved and investigational markers). We also discuss some new technologies that can aid research efforts in biological marker discovery for early UC detection. Abstract Urothelial carcinoma (UC) is the most frequent malignancy of the urinary system and is ranked the sixth most diagnosed cancer in men worldwide. Around 70–75% of newly diagnosed UC manifests as the non-muscle invasive bladder cancer (NMIBC) subtype, which can be treated by a transurethral resection of the tumor. However, patients require life-long monitoring due to its high rate of recurrence. The current gold standard for UC diagnosis, prognosis, and disease surveillance relies on a combination of cytology and cystoscopy, which is invasive, costly, and associated with comorbidities. Hence, there is considerable interest in the development of highly specific and sensitive urinary biomarkers for the non-invasive early detection of UC. In this review, we assess the performance of current diagnostic assays for UC and highlight some of the most promising biomarkers investigated to date. We also highlight some of the recent advances in single-cell technologies that may offer a paradigm shift in the field of UC biomarker discovery and precision diagnostics.
Collapse
Affiliation(s)
- Michelle Hong
- A. Menarini Biomarkers Singapore Pte Ltd., Singapore 117440, Singapore;
| | - George He
- Department of Pathology, Singapore General Hospital, Singapore 169856, Singapore; (G.H.); (S.G.); (T.K.H.L.)
| | - Siting Goh
- Department of Pathology, Singapore General Hospital, Singapore 169856, Singapore; (G.H.); (S.G.); (T.K.H.L.)
| | - Alvin Wei Xiang Low
- Department of Urology, Singapore General Hospital, Singapore 169854, Singapore; (A.W.X.L.); (K.J.T.)
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore 169854, Singapore; (A.W.X.L.); (K.J.T.)
| | - Tony Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore 169856, Singapore; (G.H.); (S.G.); (T.K.H.L.)
| | - Joe Yeong
- Department of Pathology, Singapore General Hospital, Singapore 169856, Singapore; (G.H.); (S.G.); (T.K.H.L.)
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore
- Correspondence: (J.Y.); (L.Y.K.); (T.S.L.)
| | - Li Yan Khor
- Department of Pathology, Singapore General Hospital, Singapore 169856, Singapore; (G.H.); (S.G.); (T.K.H.L.)
- Correspondence: (J.Y.); (L.Y.K.); (T.S.L.)
| | - Tong Seng Lim
- A. Menarini Biomarkers Singapore Pte Ltd., Singapore 117440, Singapore;
- Correspondence: (J.Y.); (L.Y.K.); (T.S.L.)
| |
Collapse
|
17
|
Hentschel AE, van der Toom EE, Vis AN, Ket JC, Bosschieter J, Heymans MW, van Moorselaar RJA, Steenbergen RD, Nieuwenhuijzen JA. A systematic review on mutation markers for bladder cancer diagnosis in urine. BJU Int 2021; 127:12-27. [PMID: 32539176 PMCID: PMC7818192 DOI: 10.1111/bju.15137] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To systematically summarise the available evidence on urinary bladder cancer (BC) mutation markers. Gene mutations are expected to provide novel biomarkers for urinary BC diagnosis. To date, evidence on urinary BC mutation markers has not proven sufficient to be adopted by clinical guidelines. In the present systematic review, diagnostic accuracy of urinary mutation analysis is separately assessed for primary BC diagnosis (BC detection) and for follow-up of BC patients (BC surveillance). METHODS A literature search (PubMed, Embase.com and Wiley/Cochrane Library) and systematic review was performed up to 31 October 2019. As studies were too heterogeneous, no quantitative analysis could be performed. RESULTS In total, 25 studies were summarised by qualitative analysis. For BC detection, diagnostic accuracy differed considerably for single mutation markers (sensitivity 1-85%, specificity 84-100%), and for marker panels (sensitivity 50-94%, specificity 43-97%). Similarly, for BC surveillance, diagnostic accuracy was highly variable for single mutation markers (sensitivity 0-85%, specificity 66-100%), and for marker panels (sensitivity 51-84%, specificity 66-96%). CONCLUSION Urinary mutation analysis showed to be a promising diagnostic tool for non-invasive BC diagnosis. Nonetheless, we observed substantial differences in diagnostic accuracy of urinary BC mutation markers among publications. To translate the data summarised in the present review to future clinical practice, heterogeneity in research design, BC population, mutation analysis technique and urinary DNA should be considered. Eventual clinical implementation of urinary BC mutation markers can only be achieved by collecting more and stronger evidence. Combining different molecular assays might overcome current shortcomings of urinary mutation analysis.
Collapse
Affiliation(s)
- Anouk E. Hentschel
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Emma E. van der Toom
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - André N. Vis
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Judith Bosschieter
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Martijn W. Heymans
- Amsterdam, Epidemiology & BiostatisticsAmsterdam Public HealthAmsterdamThe Netherlands
| | - R. Jeroen A. van Moorselaar
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Renske D.M. Steenbergen
- Department ofPathologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jakko A. Nieuwenhuijzen
- Department ofUrologyAmsterdam University Medical CentersCancer Center AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
18
|
Harris T, Sheel A, Zong Y, Hutchinson LM, Cornejo KM, Bubendorf L, Yates J, Fischer AH. Cytologically targeted next-generation sequencing: a synergy for diagnosing urothelial carcinoma. J Am Soc Cytopathol 2020; 10:94-102. [PMID: 33184010 DOI: 10.1016/j.jasc.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Cytology and cystoscopy are used to detect urothelial carcinoma (UC), but together they still fail to detect some UC cases and are not suitable for screening asymptomatic individuals. Mutations are present in more than 98% of UC, mutations have therapeutic significance, and they can be detected by next generation sequencing (NGS) in urine samples. We review the role of NGS in UC detection. MATERIALS AND METHODS Comprehensive literature review on UC genetics, economics of NGS, and previous reports of UC detection by NGS. RESULTS The raw costs of NGS have decreased to about 14,000 base pairs per penny, making it appear economically feasible to use NGS widely. Reported NGS assays fall short of predicted sensitivity. Decreased sensitivity is attributed to a low frequency of mutant alleles in many urine samples. Attempts to increase the percentage of mutant alleles, by using cell-free urinary DNA, or by using cell sorting and microfluidics, have been unsuccessful or remain unproven. However, cytologic examination can immediately enable NGS: Urine cytologies with sufficient proportions of abnormal cells could be directly triaged to NGS with high sensitivity for UC detection. For cases with a low proportion of abnormal cells, cytologically targeted microdissection of cells for NGS should maintain sensitivity and decrease sequencing costs. Cytologically targeted urothelial cells for NGS could allow a screening test for low grade UC. CONCLUSIONS Cytology is immediately poised to allow NGS to improve the diagnosis of UC, allowing NGS to be an ancillary test for atypical cytologies, and potentially allowing a screening test for low-grade UC.
Collapse
Affiliation(s)
- Taylor Harris
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ankur Sheel
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Yang Zong
- Department of Pathology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Lloyd M Hutchinson
- Department of Pathology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lukas Bubendorf
- Department of Pathology, University of Basel, Basel, Switzerland
| | - Jennifer Yates
- Department of Urology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Andrew H Fischer
- Department of Pathology, University of Massachusetts Memorial Health Care, Worcester, Massachusetts.
| |
Collapse
|
19
|
Lee HH, Kim SH. Review of non-invasive urinary biomarkers in bladder cancer. Transl Cancer Res 2020; 9:6554-6564. [PMID: 35117265 PMCID: PMC8798424 DOI: 10.21037/tcr-20-1990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022]
Abstract
Bladder cancer (BC) is the sixth-most prevalent cancer. The standard diagnostic tool of BC is cystoscopy, whereas cystoscopy has several disadvantages in terms of symptomatic invasiveness and operator-dependency. The urinary markers are attractive because the testing is non-invasive and cost-efficient, and sample collection is easy. Urinary marker is thereby a good tool to detect exfoliated tumor cell in the urine samples for the diagnosis and therapeutic surveillance of BC to supplement the limitations of the cystoscopy. However, they are not recommended as a population-based screening tool because of the low rate of BC prevalence. Although both cystoscopy and urine cytology improve BC diagnostic power, the field still needs additional non-invasive, cost-effective, and highly sensitive and specific diagnostic tools. Various urinary markers with different mechanisms and different targets have been developed and under investigation in these days. However, the accuracy of the urinary marker including its sensitivity and specificity is the most important factor for the diagnosis and surveillance in cancer that this review deals with multiple FDA-approved and non-FDA approved commercialized urinary markers with their accuracy in different purposes for BC. We then discuss more about the potential candidate targets for the future urinary markers in BC
Collapse
Affiliation(s)
- Hyung-Ho Lee
- Department of Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| |
Collapse
|
20
|
Ng K, Stenzl A, Sharma A, Vasdev N. Urinary biomarkers in bladder cancer: A review of the current landscape and future directions. Urol Oncol 2020; 39:41-51. [PMID: 32919875 DOI: 10.1016/j.urolonc.2020.08.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022]
Abstract
AIM This narrative review aims to describe established and emerging urinary biomarkers in the diagnosis and surveillance of non-muscle invasive bladder cancer. It provides a comprehensive account of classical, FDA-approved protein biomarkers and discusses their limitations. Further, we discuss the role that epigenetic, genetic, and exosomal markers can play to enhance sensitivity and specificity of the available tests. BACKGROUND The initial diagnosis and surveillance of bladder cancer involves a combination of cystoscopy, upper urinary tract imaging, and urine cytology. Despite high specificity, cytology is limited by low sensitivity. There are currently 6 urinary assays approved by the FDA to enhance diagnosis and surveillance of bladder cancer. While these have improved diagnosis and surveillance when combined with cytology, these tests are still not sufficiently sensitive and false positives often occur in benign conditions which result in inflammation of the urinary tract. Advancements in laboratory techniques have produced significant advancements in epigenetic and genetic markers, as well as extracellular vesicles, with DNA- and RNA-based markers dominating the research in this area in recent years. METHODS We identified relevant published data, using the PubMed/ Medline search engines as well as Google Scholar. We performed an online search using the terms "bladder cancer", "non-muscle invasive bladder cancer" in combination with "urine biomarkers" and limited articles in English published up to February 2020. This review consolidated on all available narrative and systematic reviews published in the 5 years in this field, while also reviewing the original data of each clinical trial or observational study which led to the development of the biomarkers. CONCLUSION The development of laboratory techniques and understanding urine-based biomarkers in BC has fuelled the use of noninvasive liquid-based biomarkers to complement urine cytology. Nonetheless, none are sufficiently effective when used in isolation, and cytology remains the gold standard in many practices. Future efforts will be focused on using these markers in combination as a predictive signature, and moving on to validating them for use in everyday clinical practice.
Collapse
Affiliation(s)
- Kenrick Ng
- UCL Cancer Institute, London, United Kindom
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, United Kindom
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, United Kindom; School of Life and Medical Sciences, University of Hertfordshire, United Kindom.
| |
Collapse
|
21
|
Mentis AFA, Grivas PD, Dardiotis E, Romas NA, Papavassiliou AG. Circulating tumor cells as Trojan Horse for understanding, preventing, and treating cancer: a critical appraisal. Cell Mol Life Sci 2020; 77:3671-3690. [PMID: 32333084 PMCID: PMC11104835 DOI: 10.1007/s00018-020-03529-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/29/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
Circulating tumor cells (CTCs) are regarded as harbingers of metastases. Their ability to predict response to therapy, relapse, and resistance to treatment has proposed their value as putative diagnostic and prognostic indicators. CTCs represent one of the zeniths of cancer evolution in terms of cell survival; however, the triggers of CTC generation, the identification of potentially metastatic CTCs, and the mechanisms contributing to their heterogeneity and aggressiveness represent issues not yet fully deciphered. Thus, prior to enabling liquid biopsy applications to reach clinical prime time, understanding how the above mechanistic information can be applied to improve treatment decisions is a key challenge. Here, we provide our perspective on how CTCs can provide mechanistic insights into tumor pathogenesis, as well as on CTC clinical value. In doing so, we aim to (a) describe how CTCs disseminate from the primary tumor, and their link to epithelial-mesenchymal transition (EMT); (b) trace the route of CTCs through the circulation, focusing on tumor self-seeding and the possibility of tertiary metastasis; (c) describe possible mechanisms underlying the enhanced metastatic potential of CTCs; (d) discuss how CTC could provide further information on the tissue of origin, especially in cancer of unknown primary origin. We also provide a comprehensive review of meta-analyses assessing the prognostic significance of CTCs, to highlight the emerging role of CTCs in clinical oncology. We also explore how cell-free circulating tumor DNA (ctDNA) analysis, using a combination of genomic and phylogenetic analysis, can offer insights into CTC biology, including our understanding of CTC heterogeneity and tumor evolution. Last, we discuss emerging technologies, such as high-throughput quantitative imaging, radiogenomics, machine learning approaches, and the emerging breath biopsy. These technologies could compliment CTC and ctDNA analyses, and they collectively represent major future steps in cancer detection, monitoring, and management.
Collapse
Affiliation(s)
- Alexios-Fotios A Mentis
- Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece
- Department of Microbiology, University Hospital of Thessaly, Larissa, Greece
| | - Petros D Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Nicholas A Romas
- Department of Urology, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 M. Asias Street-Bldg. 16, 11527, Athens, Greece.
| |
Collapse
|
22
|
Zhang ML, VandenBussche CJ, Hang JF, Miki Y, McIntire PJ, Peyton S, Vohra P. A review of urinary cytology in the setting of upper tract urothelial carcinoma. J Am Soc Cytopathol 2020; 10:29-35. [PMID: 32792229 DOI: 10.1016/j.jasc.2020.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
Abstract
Urothelial carcinomas of the upper urinary tract (UUT) are uncommon. Cytological examination of voided urine or washings from the UUT has been part of the standard workup for upper tract urothelial carcinoma (UTUC); however, its value remains controversial. The lack of uniform terminology and specific diagnostic criteria could also have contributed to the inferior performance of urinary cytology for detecting UTUC. The Paris System for Reporting Urinary Cytology (TPS) has provided a standardized reporting system for urinary cytology specimens with clearly defined cytomorphologic diagnostic criteria and found acceptance on an international level after its implementation in 2016. Recent studies have shown that TPS has led to improved diagnostic performance of urinary cytology; however, most of these studies had focused on the evaluation of lower urinary tract cytology specimens. Only a limited number of new research studies have analyzed the effect of TPS when applied to UUT cytology specimens. In the present report, we have summarized the current understanding and utility of UTUC, including its molecular biology, and reviewed the current literature.
Collapse
Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yurina Miki
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Stephen Peyton
- Department of Anatomical Pathology, QML Pathology, Brisbane, Queensland, Australia
| | - Poonam Vohra
- Department of Anatomic Pathology, University of California, San Francisco, San Francisco, California.
| |
Collapse
|
23
|
Batista R, Vinagre N, Meireles S, Vinagre J, Prazeres H, Leão R, Máximo V, Soares P. Biomarkers for Bladder Cancer Diagnosis and Surveillance: A Comprehensive Review. Diagnostics (Basel) 2020; 10:diagnostics10010039. [PMID: 31941070 PMCID: PMC7169395 DOI: 10.3390/diagnostics10010039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
Bladder cancer (BC) ranks as the sixth most prevalent cancer in the world, with a steady rise in its incidence and prevalence, and is accompanied by a high morbidity and mortality. BC is a complex disease with several molecular and pathological pathways, thus reflecting different behaviors depending on the clinical staging of the tumor and molecular type. Diagnosis and monitoring of BC is mainly performed by invasive tests, namely periodic cystoscopies; this procedure, although a reliable method, is highly uncomfortable for the patient and it is not exempt of comorbidities. Currently, there is no formal indication for the use of molecular biomarkers in clinical practice, even though there are several tests available. There is an imperative need for a clinical non-invasive testing for early detection, disease monitoring, and treatment response in BC. In this review, we aim to assess and compare different tests based on molecular biomarkers and evaluate their potential role as new molecules for bladder cancer diagnosis, follow-up, and treatment response monitoring.
Collapse
Affiliation(s)
- Rui Batista
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- U-Monitor Lda, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Nuno Vinagre
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Sara Meireles
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Oncology, Hospital Centre of S. João, 4200-319 Porto, Portugal
| | - João Vinagre
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- U-Monitor Lda, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Hugo Prazeres
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- U-Monitor Lda, 4200-135 Porto, Portugal
- Pathology Service, Portuguese Institute of Oncology Francisco Gentil (IPO-Coimbra), 3000-075 Coimbra, Portugal
| | - Ricardo Leão
- Urology department, Hospital de Braga, 4710-243 Braga, Portugal;
- Urology department, Hospital CUF Coimbra, 3000-600 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
| | - Valdemar Máximo
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Paula Soares
- i3S–Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal; (R.B.); (N.V.); (S.M.); (J.V.); (H.P.); (V.M.)
- Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-225-570-700
| |
Collapse
|