The utility of fibrin/fibrinogen degradation products in superficial bladder cancer

Prediction of Poor Outcomes in Patients with Colorectal Cancer: Elevated Preoperative Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT)

Background and Objective

Tools for the non-invasive assessment of colorectal cancer (CRC) prognosis have profound significance. Although plasma coagulation tests have been investigated in a variety of tumours, the prognostic value of the prothrombin time (PT) and activated partial thromboplastin time (APTT) in CRC has not been discussed. Our study objective was to explore the prognostic significance of preoperative PT and APTT in CRC patients.

Patients and Methods

A retrospective analysis of preoperative coagulation indexes including PT, PTA, INR, APTT, FIB, TT, PLT, NLR and PLR in 250 patients with CRC was performed. Kaplan–Meier and multivariate Cox regression analysis were used to demonstrate the prognostic value of these preoperative coagulation indexes.

Results

The overall survival (OS, p<0.05) and disease-free survival (DFS, p<0.05) of CRC patients with lower PT and APTT levels were significantly prolonged. Based on univariate analysis, PT levels (p<0.001, p<0.001), PTA levels (p=0.001, p=0.001), APTT levels (p=0.001, p<0.001), INR levels (p<0.001, p<0.001), fibrinogen levels (p=0.032, p=0.036), tumour status (p=0.005, p=0.003), nodal status (p<0.001, p<0.001), metastasis status (p<0.001, p<0.001) and TNM stages (p<0.001, p<0.001) were remarkably associated with DFS and OS. Multivariate Cox regression analysis suggested that the levels of PT (HR: 2.699, p=0.006) and APTT (HR: 1.942, p=0.015), metastasis status (HR: 2.091, p= 0.015) and TNM stage (HR: 7.086, p=0.006) were independent predictors of survival in CRC. In the whole cohort, the enrolled patients were then divided into three groups according to their PT and APTT levels. The OS and DFS differed notably among the low-risk (PT<11.85 sec and APTT<25.85 sec), medium-risk (PT≥11.85 sec or APTT≥25.85 sec), and high-risk (PT≥11.85 sec and APTT≥25.85 sec) groups.

Conclusion

Elevated levels of preoperative PT and APTT were predictors of poor outcomes in CRC patients. Moreover, the combination of preoperative PT and APTT can be a new prognostic stratification approach for more precise clinical staging of CRC.

Urinary peptide panel for prognostic assessment of bladder cancer relapse

Non-invasive tools stratifying bladder cancer (BC) patients according to the risk of relapse are urgently needed to guide clinical intervention. As a follow-up to the previously published study on CE-MS-based urinary biomarkers for BC detection and recurrence monitoring, we expanded the investigation towards BC patients with longitudinal data. Profiling datasets of BC patients with follow-up information regarding the relapse status were investigated. The peptidomics dataset (n = 98) was split into training and test set. Cox regression was utilized for feature selection in the training set. Investigation of the entire training set at the single peptide level revealed 36 peptides being strong independent prognostic markers of disease relapse. Those features were further integrated into a Random Forest-based model evaluating the risk of relapse for BC patients. Performance of the model was assessed in the test cohort, showing high significance in BC relapse prognosis [HR = 5.76, p-value = 0.0001, c-index = 0.64]. Urinary peptide profiles integrated into a prognostic model allow for quantitative risk assessment of BC relapse highlighting the need for its incorporation in prospective studies to establish its value in the clinical management of BC.

Bladder Tumor Markers: A Review of the Literature

Bladder cancer is among the top eight most frequent cancers. Its natural history is related to a combination of factors that impact on its aggressiveness. Cystoscopy and urine cytology are the currently used techniques for the diagnosis and surveillance of non-invasive bladder tumors. The sensitivity of urine cytology for diagnosis is not high, particularly in low-grade tumors. The combination of voided urine cytology and new diagnostic urine tests would be ideal for the diagnosis and follow-up of bladder cancer. However, in order to have some clinical utility, new diagnostic and/or prognostic markers should achieve better predictive capacity that the currently used diagnostic tools. None of the markers evaluated over the last years showed remarkable sensitivity or specificity for the identification of any of the diverse types of bladder cancer in clinical practice. The limitations of the known prognostic markers have led to the research of new molecular markers for early detection of bladder cancer. This research focused in particular on the discovery of biomarkers capable of reducing the need for periodic cystoscopies or, ideally, offering a non-invasive examination instead. In this review, we will examine various new markers of bladder cancer and their value in the diagnosis and follow-up of non-muscle-invasive bladder cancer. When compared with urine cytology, which showed the highest specificity, most of these markers demonstrated an increased sensitivity.

Screening candidate genes associated with bladder cancer using DNA microarray

The aim of the present study was to screen candidate genes that are closely associated with bladder cancer and to select the most distinct candidate target genes in order to provide theoretical evidence and direction for improved treatment of bladder cancer. The gene microarray dataset GSE45184 was downloaded from the Gene Expression Omnibus database. There were a total of six expression prolife microarrays from three pairs of freshly frozen bladder cancer tissues and corresponding normal adjacent tissues. Differentially expressed genes (DEGs) were identified using the limma package in R software and then subjected to further biological information analysis, including hierarchical clustering analysis and gene ontology enrichment analysis. Co‑expression networks and functional interaction networks were established using the up‑ and downregulated genes. Pathway enrichment analysis was then performed for the genes in the functional interaction networks. A total of 522 DEGs were identified, including 223 upregulated and 299 downregulated genes. Functional enrichment analysis of the target genes indicated that downregulated genes were associated with the regulation of biological processes, while the upregulated genes participated in the processes involved in the cell cycle. The functional network of the upregulated genes comprised 1,518 connections and 92 gene nodes that were associated with 10 closely‑related functions, while the network of the downregulated genes consisted of 129 connections and 24 gene nodes involving 11 significantly related functions. Pathway enrichment analysis revealed that the downregulated genes were mainly involved in the mitogen‑activated protein kinase signaling pathway, while the upregulated genes were closely associated with the cell cycle. These DEGs and the relevant cell cycle pathways have the potential to be used as targets for the treatment of bladder cancer.

Nucleophosmin1 associated with drug resistance and recurrence of bladder cancer

Drug resistance and recurrence are the major obstacles to bladder cancer chemotherapy. Our laboratory had reported that nucleophosmin1 was one of the differentially expressed proteins between bladder cancer cell lines PUMC-91 and PUMC-91/1.0ADM based on 2D-PAGE proteomics approaches. In this study, we want to explore the relationship among nucleophosmin1, drug resistance, and recurrence of bladder cancer, using normal bladder epithelia cell line SV-HUC-1, bladder cancer cell lines PUMC-91, PUMC-91 against gradient doses of adriamycin (0.3, 0.6, and 1.0 μg/ml), and bladder cancer tissue samples. The bladder cancer tissue samples were divided into two groups according to the interval of recurrence (<6 months and >2 years). The differences were detected by Western blotting and immunohistochemistry. The protein of nucleophosmin1 was differentially expressed with each other in SV-HUC-1, PUMC-91, PUMC-91/0.3ADM, and PUMC-91/1.0ADM (p < 0.05). Nucleophosmin1 was less expressed in later recurring (>2 years) bladder cancer tissue samples compared with samples that recurred <6 months (p = 0.035). The expression of nucleophosmin1 was independently associated with gradient drug resistance and recurrent frequency of bladder cancer. Nucleophosmin1 was a key regulator in either a drug-resistant bladder cancer or bladder cancer recurrence model. It may be possible to think nucleophosmin1 can provide more helpful information for clinical drug treatment of bladder cancer patients and frequently recurred ones.

Colorectal cancer and hypercoagulability

Since the first report of the spontaneous appearance of venous thrombophlebitis as a sign of visceral cancer by Trousseau in 1865, many other studies have documented the existence of cancer-associated coagulation disorders. In this review, we describe the hypercoagulable state associated with colorectal cancer, from three perspectives: first, the incidence, risk factors and prevention of clinically symptomatic thromboembolic conditions associated with cancer, such as venous thromboembolism and arterial thrombosis; second, the association between hypercoagulable conditions, such as thrombocytosis, hyperfibrinogenemia, or D-dimer elevation, and the clinical progression and poor prognosis of cancer patients; third, the experimental approach to elucidate the role of various coagulation-related factors in the process of cancer progression, focusing specifically on the role of platelets and tissue factors.

Urine telomerase for diagnosis and surveillance of bladder cancer

Bladder cancer has increased incidence during last decades. For those patients with nonmuscle involved tumors, noninvasive diagnosis test and surveillance methods must be designed to avoid current cystoscopies that nowadays are done regularly in a lot of patients. Novel urine biomarkers have been developed during last years. Telomerase is important in cancer biology, improving the division capacity of cancer cells. Even urinary telomerase could be a potentially useful urinary tumor marker; its use for diagnosis of asymptomatic and symptomatic patients or its impact during surveillance is still unknown. Moreover, there will need to be uniformity and standardization in the assays before it can become useful in clinical practice. It does not seem to exist a real difference between the most classical assays for the detection of urine telomerase (TRAP and hTERT). However, the new detection methods with modified TeloTAGGG telomerase or with gold nanoparticles must also be taken into consideration for the correct development of this diagnosis method. Maybe the target population would be the high-risk groups within screening programs. To date there is no enough evidence to use it alone and to eliminate cystoscopies from the diagnosis and surveillance of these patients. The combination with cytology or FISH is still preferred.

B domain containing Tenascin-C: a new urine marker for surveillance of patients with urothelial carcinoma of the urinary bladder?

BACKGROUND

ECM remodelling during tumorigenesis entails the re-occurrence of different Tn-C(L) splicing variants. In patients with urothelial carcinoma of the urinary bladder (UBC), B and C domain containing Tenascin-C (B(+) and C(+) Tn-C) urine levels were shown to be increased in case of muscle invasiveness. Thus, the present study was aimed at examining the ability of B(+) and C(+) Tn-C as potential urinary surveillance markers of UBC patients.

METHODS

Urine levels of B(+) and C(+) Tn-C were determined by ELISA in 35 UBC patients during a 2 year follow-up period after therapy and related to clinical diagnosis and histological stage in 4 defined groups representing typical courses of disease.

RESULTS

B(+) Tn-C levels showed significant differences between cases of tumour progression or regression. The urine levels of B(+) Tn-C could be used to discriminate between cases without tumour recurrence and such with tumour existence (cut-off value: 0.8 ng/ml) or between non-muscle invasive and muscle invasive tumour growth (cut-off value: 3.5 ng/ml).

CONCLUSIONS

Progression of UBC with time is accompanied by significant changes in urinary levels of B(+) Tn-C. Urinary B(+) Tn-C can therefore be suggested as a valuable urine surveillance marker in UBC follow-up care.

Molecular pathogenesis and diagnostics of bladder cancer

Despite elaborate characterization of the risk factors, bladder cancer is still a major epidemiological problem whose incidence continues to rise each year. Urothelial carcinoma is now recognized as a disease of alterations in several cellular processes. The more prevalent, less aggressive, recurrent, noninvasive tumors are characterized by constitutive activation of the Ras-MAPK pathway. The less common but more aggressive invasive tumors, which have a higher mortality rate, are characterized by alterations in the p53 and retinoblastoma pathways. Several diagnostic tests have attempted to identify these molecular alterations in tumor cells exfoliated in the urine, whereas prognostic tests have tried to identify aberrations so as to predict tumor behavior and identify therapeutic targets. The future of bladder cancer patient management will rely on the use of molecular tests to reliably diagnose the presence of disease, predict individual tumor behavior, and suggest potential targeted therapeutics.

Proteomic strategies in bladder cancer: From tissue to fluid and back

We have applied protein expression profiling technologies in combination with immunohistochemistry, using fresh tissue and urine samples, to assess bladder cancer heterogeneity and prognosis as well as to generate protein markers for tumor progression and early diagnosis of the disease. Here, we review some selected lines of investigation and approaches undertaken by our laboratory, drawing on more than 15 years of experience in bladder cancer proteomics, to highlight a number of issues that may be useful for researchers entering the field. In particular, we address the identification of markers for bladder cancer progression and exemplify the potential of gel-based proteomic profiling of urine samples for the early detection of urothelial carcinomas. In addition, we provide a brief description of a novel and highly promising source of biomarkers, the tumor interstitial fluid (TIF) that perfuses the tumor microenvironment.

An endogenous inhibitor of angiogenesis derived from a transitional cell carcinoma: clipped beta2-glycoprotein-I

BACKGROUND

Invasive cell carcinoma of the bladder often develops after complete transurethral excision of superficial transitional cell carcinoma. It has been postulated that primary tumors release angiogenesis-blocking proteins which suppress distant metastases. We have identified an endogenous protein which might be responsible for tumor dormancy.

METHODS

A transitional cell carcinoma cell line was developed (UMUC-3i) which inhibits the growth of a tumor implant at a distant site in SCID mice. Conditioned media of UMUC-3i cultured cells was first pooled and then fractioned, and the capacity of individual components to block endothelial cell growth was tested. The protein fraction responsible for blocking endothelial cell growth was identified by N-terminal amino acid sequencing as well as by mass-spectrometry. The effects of the purified protein in preventing endothelial cell proliferation and tube formation in an in vitro angiogenesis assay was investigated.

RESULTS

The plasma protein beta(2)-glycoprotein-I (beta(2)gpI) was isolated and identified from conditioned medium of UMUC-3i cultured cells. Based on the in vitro angiogenesis assay, beta(2)gpI strongly inhibited endothelial cell growth and tube formation, whereby the inhibitory activity corresponded to the clipped version of beta(2)gpI (cbeta(2)gpI). Clipping was induced by adding plasmin at a molar ratio 1:15 (plasmin:substrate). Further analysis indicated that cbeta(2)gpI effects were mediated by annexin II surface receptors expressed on endothelial cells.

CONCLUSIONS

cbeta2gpI may be involved in blocking angiogenic processes and bladder cancer progression. In this case, cbeta2gpI may be a promising tool in bladder cancer therapy.

Proteomics approaches to urologic diseases

Biomarkers are greatly needed for several urologic diseases, such as interstitial cystitis, the symptomatic and clinical progression of benign prostate hyperplasia, as well as the specific detection of urologic cancers, including prostate and bladder cancer. This review aims to: briefly describe the need for biomarkers in the field and biomarkers that are currently available for clinicians; address the limitations and roadblocks to effective biomarker discovery; and provide examples and strategies for implementing biomarkers in clinical practice and/or drug discovery.

Early bladder cancer: concept, diagnosis, and management

Recent evidence on molecular pathways helps us to understand the pathogenesis of bladder cancer. However, the molecular mechanisms of recurrence of the disease and progression into muscle-invasive disease are not fully understood. The diagnostic accuracy and specificity of innovative markers for detection of the disease currently available in the clinical setting are still far from the level where cystoscopy would not be needed. Although risk factors for progression to muscle-invasive disease have been identified, we still cannot predict accurately the clinical behavior of superficial bladder cancer. In this review article, we summarize recent evidence on molecular pathogenesis, risk factors for recurrence and progression, urine markers for detection, and treatments in superficial bladder cancer.

Rapid diagnosis and follow up of bladder cancer patients using urinary high molecular weight cytokeratins

We have developed an office-based dot-EIA for the detection of a urinary high molecular weight cytokeratin (CK). Immunohistochemical staining and western blot based on CK1K10 monoclonal antibody were used to identify the CK. Urine of 192 patients with different types, grades, and stages of bladder tumor and 72 controls were evaluated using dot-EIA. An intense and diffuse cytoplasmic reaction was shown in bladder squamous cell carcinoma. The target epitope was identified in urine at 65, 56, and 40-kDa. The CK purified from urine showed single polypeptide at 65-kDa using SDS-PAGE and single peak at 7.4 min using capillary zone electrophoresis. The dot-EIA detected the CK with high sensitivity (97%) and specificity (94%). The CK was not detected in urine of bladder cancer patients showing response to radiotherapy. The sensitive and specific office-based detection of urinary cytokeratin would be helpful in rapid diagnosis and follow up of bladder carcinoma.

Non-invasive diagnostic tests for bladder cancer: a review of the literature

Transitional cell carcinoma of the bladder is the second most common malignancy of the genitourinary tract. Cystoscopy and urine cytology are the traditional most used techniques for diagnosis and surveillance of superficial bladder cancer. Urine cytology is specific for diagnosis of bladder cancer but sensitivity results not high, particularly in low-grade disease. Voided urine can be easily obtained and therefore additional diagnostic urine tests would be ideal for screening or follow-up of transitional cell carcinoma. A number of studies have focused on the evaluation of urinary markers that hold promise as non-invasive adjuncts to conventional diagnostic or surveillance techniques. In this review we discuss several new urinary markers (test for bladder tumor antigen, NMP22, fibrin degradation products, telomerase, fluorescence in situ hybridization test, flow cytometry) and their role in detection and follow-up of bladder cancer. Most of these markers have higher sensitivity than urine cytology, but voided urine cytology has the highest specificity.

Urinary markers of bladder carcinoma

PURPOSE

Transitional cell carcinoma of bladder is one of the most common tumors of genitourinary tract. Cystoscopy along with cytology is the mainstay for diagnosing bladder cancer. Cytology is specific for diagnosis of bladder carcinomas but less sensitive particularly in low-grade disease. Cystoscopy on the other hand is invasive and relatively costly technique and may also be inconclusive at times particularly in case of cystitis. A simple noninvasive marker for detecting bladder cancer would be helpful. A clinically useful urinary marker should be easy to perform, should have minimum requirements for sample preparations and should have high sensitivity and specificity in diagnosis. In this review we discussed the various urinary markers and their role in detection of bladder cancer.

MATERIALS AND METHODS

We reviewed the literature on urinary markers and tests that may have clinical usefulness.

RESULTS

Several urinary markers and tests such as BTA Stat, BTA TRAK, NMP22, telomerase, HA and HAse tests, Immunocyt, Quanticyt, FDP, BLCA-4, FISH, CYFRA-21-1 have enough potential for future clinical use. BTA stat, NMP22 (bladder check)and AccuDX (FDP) tests are presently point of care tests. The rest of the tests are laboratory-based and may need trained technicians. Majorities of the urinary markers have higher sensitivity and specificity than cytology. However, voided urinary cytology has the highest specificity.

CONCLUSIONS

Till now there is no urinary marker or test that can replace the need of cystoscopy. However, some markers have the potential for future clinical use.

Urine based markers of urological malignancy

PURPOSE

A number of urine based markers have been and are being investigated for the diagnosis and prognostication of urological conditions. A majority of these markers have been evaluated in urological neoplasms, particularly bladder cancer. The diagnosis of bladder cancer currently relies on identifying malignant cells in the urine and subsequently visualizing the tumor on cystoscopy. This diagnosis is further confirmed by transurethral resection or biopsy. While urine cytology is specific, it is not sensitive, especially for detecting low grade disease. This characteristic has prompted the search for more accurate markers of bladder cancer. In this review we critically examine the results of studies evaluating various markers for bladder cancer.

MATERIALS AND METHODS

The published literature on urine based markers for all urological diseases, particularly bladder cancer, was identified using a MEDLINE search and critically analyzed. The sensitivity, specificity, positive and negative predictive values of the various markers were compared. The benefit of using combined markers rather than a single marker was also analyzed from published reports.

RESULTS

Most published literature on urine based markers for urological malignancies involve such markers for diagnosing and prognosticating bladder cancer. Hence, we focused mainly on urine based markers in bladder cancer. Most markers appear to have an advantage over urine cytology in terms of sensitivity, especially for detecting low grade, superficial tumors. However, most markers tend to be less specific than cytology, yielding more false-positive results. This scenario is more common in patients with concurrent bladder inflammation or other benign bladder conditions. However, there is reason to be optimistic about several new markers that appear to provide better specificity. Few urine based markers have been identified and investigated in other urological tumors.

CONCLUSIONS

Detecting bladder cancer using diagnostic markers still presents a challenge. A number of new markers are currently available that appear to be significantly more accurate than cytology. However, further studies involving a larger number of patients are required to determine their accuracy and widespread applicability for diagnosing bladder cancer. Urine based markers do not appear to have a significant role in the diagnosis or prognosis of other urological malignancies, such as prostate, kidney or testicular cancer.

Biomarkers for the detection of bladder cancer

In this subject review, a series of morphology-based and molecular markers were compared with urinary cytology for the detection of recurrent urothelial neoplasia. Among the various biomarkers reviewed, the average published sensitivity and specificity for the Bard BTA test was 60% and 77%; the NMP22 Test was 67% and 72%; the telomerase assay was 77% and 85%; and the microsatellite assay was 89% and 100%. DNA ploidy measurements and immunoassays designed to detect keratins, proteins, hyaluronidase, growth factors, cell adhesion molecules, fibrinogen degradation products, cell cycle regulators, and molecular markers were also included. Although the performance features of these biomarkers have varied and the cytologic methods to which they have been compared have not been standardized, several of the procedures have received considerable support from urologists as assisting them in the management of their patients.

Reduced expression of PSCA, a member of the LY-6 family of cell surface antigens, in bladder, esophagus, and stomach tumors

Prostate stem cell antigen (PSCA) is a member of the LY-6 family of surface proteins that is overexpressed in prostate cancer. Using serial analysis of gene expression (SAGE), we identified PSCA as one of the most abundant transcripts in a differentiated urothelial tumor. As assessed by Northern blotting, PSCA is highly expressed in normal urothelium and noninvasive urothelial tumors. In contrast to the previously reported overexpression of PSCA in progressive and invasive forms of prostate cancer, we found a markedly reduced expression in undifferentiated bladder carcinoma. In addition, several aberrant splicing products derived from the PSCA gene were found in urothelial tumors. Furthermore, PSCA mRNA was highly abundant in normal esophagus and stomach, but was undetectable in esophageal or gastric tumors. The PSCA expression appeared to depend on cell contact, since mRNA levels were increased when RT112 bladder carcinoma cells were grown to confluence. Our data suggest that PSCA could serve as a potential marker for the early carcinogenesis in urothelial and gastric tissues and that its expression is specific for epithelial cells.