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Dreyer T, Ernst A, Jensen JB. Optimal intervals for follow-up cystoscopy in non-muscle invasive bladder cancer: a systematic review regarding oncological safety. Scand J Urol 2021; 56:39-46. [PMID: 34913840 DOI: 10.1080/21681805.2021.2014562] [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: 10/19/2022]
Abstract
CONTEXT Improving efficiency of follow-up for non-muscle invasive bladder tumours (NMIBC) without risking disease progression through delays of recurrence diagnosis, is a highly relevant field of research. OBJECTIVE The aim of our systematic review was to investigate whether the available evidence support alternative follow-up cytoscopic schedules with respect to oncological safety, compared to those currently given in clinical guidelines for NMIBC. Evidence acquisition we included prospective studies investigating cystoscopy based follow-up schedules including, but not restricted to, comparison of two or more different follow-up schedules with respect to oncological safety measured by recurrence free survival, progression free survival, and overall survival. We allowed for supplementation of modalities such as urinary biomarkers. We screened 680 studies identified by a systematic literature search and, based on our inclusion and exclusion criteria, we included three studies for the narrative synthesis of evidence. CONCLUSION In our systematic search of the literature, we found only low level evidence to support current or alternative cystoscopic follow-up schedules. Clinical trials directly aimed at investigating novel follow-up schedules for NMIBC are needed before substantial changes to existing clinical guidelines can be made.
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Affiliation(s)
- Thomas Dreyer
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Ernst
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cowan B, Klein E, Jansz K, Westenfelder K, Bradford T, Peterson C, Scherr D, Karsh LI, Egerdie B, Witjes A, Trainer A, Harris R, Goldfarb B, Flax S, Kroeger R, Boyd B, Liao J, Patel S, Bridge J, Reuter V, Quigley N, Brown S, Zhao S, Satya M, Bates M, Simon IM, Campbell S, Lotan Y. Longitudinal follow-up and performance validation of an mRNA-based urine test (Xpert ® Bladder Cancer Monitor) for surveillance in patients with non-muscle-invasive bladder cancer. BJU Int 2021; 128:713-721. [PMID: 33793062 PMCID: PMC9292663 DOI: 10.1111/bju.15418] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective To evaluate the performance of the Xpert Bladder Cancer Monitor (Xpert; Cepheid, Sunnyvale, CA, USA) test as a predictor of tumour recurrence in patients with non‐muscle‐invasive bladder cancer (NMIBC). Patients and Methods Patients (n = 429) undergoing surveillance for NMIBC underwent Xpert, cytology, and UroVysion testing. Patients with a positive Xpert and a negative cystoscopy result (positive‐negative [PN] group, n = 66) and a control group of double negative patients (negative Xpert and cystoscopy results [NN] group) were followed for 12 months (±90 days). Results Histology‐confirmed recurrences were detected in 58 patients (13.5%). Xpert had an overall sensitivity of 60.3% and a specificity of 76.5%. The sensitivity for high‐grade (HG) cancer was 87% with a negative predictive value (NPV) of 99%. Urine cytology showed an overall sensitivity of 23.2% (47.6% sensitivity for HG tumours) and a specificity of 88.3%. In the PN group, 32% (n = 21) developed a recurrence within 12 months, 11 of which were HG tumours. In the NN control group, 14% (n = 9) developed a recurrence and only two were HG tumours. The hazard ratio for developing recurrence in the PN group was 2.68 for all tumours and 6.84 for HG cancer. Conclusions The Xpert test has a high sensitivity for detecting the recurrence of cancer and a high NPV for excluding HG cancer. In addition, the data suggest that patients with a positive Xpert assay in the setting of negative cystoscopy are at high risk for recurrence and need close surveillance.
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Affiliation(s)
| | - Eric Klein
- Idaho Urologic Institute, Meridian, ID, USA
| | - Ken Jansz
- Jansz Medicine Professional Corp, Burlington, ON, Canada
| | | | | | | | | | | | - Blair Egerdie
- Urology Associates/Urology Medical Research, Kitchener, ON, Canada
| | - Alfred Witjes
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | - Buffi Boyd
- Urology Associates of Savannah, Savannah, GA, USA
| | - Joseph Liao
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sanjay Patel
- Stephenson Cancer Centre, Oklahoma City, OK, USA
| | - Julia Bridge
- University of Nebraska Medical Centre, Omaha, NE, USA
| | | | - Neil Quigley
- Geneuity Clinical Research Services, Maryville, TN, USA
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Cancel-Tassin G, Roupret M, Pinar U, Gaffory C, Vanie F, Ondet V, Compérat E, Cussenot O. Assessment of Xpert Bladder Cancer Monitor test performance for the detection of recurrence during non-muscle invasive bladder cancer follow-up. World J Urol 2021; 39:3329-3335. [PMID: 33770241 PMCID: PMC7994915 DOI: 10.1007/s00345-021-03629-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess the performance of the Xpert Bladder Cancer (BC) Monitor during the follow-up of patients with non-muscle invasive bladder cancer (NMIBC). Methods Patients with previously diagnosed NMIBC and followed up in clinical practice settings in two French urology departments between September 2017 and July 2019 were consecutively enrolled in this prospective observational study. Patients with a positive cystoscopy or computed tomography urogram underwent subsequent transurethral resection of the bladder, and/or biopsy, and the specimens were pathologically assessed. Cytology and Xpert BC Monitor tests were performed on urine samples. Xpert BC Monitor performance was assessed versus cystoscopy for disease-negative patients or versus histology for disease-positive patients, and was compared to that of cytology. Results Overall, 500 patients with a median age of 70.0 years were included. NMIBC recurrence was diagnosed in 44 cases (8.8%). Overall sensitivity, specificity, and negative predictive values (NPVs) were 72.7% (32/44), 73.7% (330/448) and 96.5% (330/342) for the Xpert BC Monitor, and 7.7% (2/26), 97.8% (310/317) and 92.8% (310/334) for cytology, respectively. The Xpert BC Monitor detected 92.3% (12/13) of the high-grade tumours and ruled out their presence in 99.7% (330/331) of cases. Analysis of the areas under the receiver operating characteristic curves demonstrated the superior performance of the Xpert BC Monitor over that of cytology. Conclusion Xpert BC Monitor performance was superior to that of cytology in the follow-up of NMIBC. The exclusion of aggressive tumours with a very high NPV (99.7%) supports the use of this urinary test in daily practice.
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Affiliation(s)
- G Cancel-Tassin
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France
| | - M Roupret
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - U Pinar
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France
| | - C Gaffory
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France
| | - F Vanie
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - V Ondet
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France
| | - E Compérat
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France.,Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Olivier Cussenot
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France. .,CeRePP, Hôpital Tenon, 75020, Paris, France.
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