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Parrao D, Lizana N, Saavedra C, Larrañaga M, Lindsay CB, San Francisco IF, Bravo JC. Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review. Curr Oncol 2024; 31:2201-2220. [PMID: 38668066 PMCID: PMC11048875 DOI: 10.3390/curroncol31040163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.
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Affiliation(s)
- Diego Parrao
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Nemecio Lizana
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Catalina Saavedra
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Matías Larrañaga
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Carolina B. Lindsay
- Research Department, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Ignacio F. San Francisco
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Juan Cristóbal Bravo
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
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2
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Ecke TH, Meisl CJ, Schlomm T, Rabien A, Labonté F, Rong D, Hofbauer S, Friedersdorff F, Sommerfeldt L, Gagel N, Gössl A, Barski D, Otto T, Grunewald CM, Niegisch G, Hennig MJP, Kramer MW, Koch S, Roggisch J, Hallmann S, Weiß S, Waldner M, Graff J, Veltrup E, Linden F, Hake R, Eidt S, Wirtz RM. BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL as urinary marker for bladder cancer: Final results of a German multicenter study. Urol Oncol 2023; 41:484.e17-484.e26. [PMID: 37407421 DOI: 10.1016/j.urolonc.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION AND OBJECTIVE BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, and CancerCheck® UBC® rapid VISUAL are urinary-based rapid tests. This multicenter study is the first study comparing all available rapid tests on a large cohort of bladder cancer patients and healthy controls in one setting. METHODS In total 732 urine samples (second morning urine) in a real-world assessment have been analyzed. We evaluated clinical samples from 464 patients with histologically confirmed urothelial tumors of the urinary bladder (17 solitary CIS, 189 low-grade, 187 high-grade nonmuscle invasive, 71 high-grade muscle invasive), 77 patients with No Evidence of Disease (NED), and from 191 healthy controls. Urine samples were analyzed by the BTA stat®, NMP22® BladderChek®, UBC® Rapid Test point-of-care (POC) system using the concile Omega 100 POC reader, and CancerCheck® UBC® rapid VISUAL. Sensitivities and specificities were calculated by contingency analyses. RESULTS All investigated urinary markers detected more pathological concentrations in urine of bladder cancer patients compared to tumor-free patients. The calculated diagnostic sensitivities for BTA stat®, NMP22® BladderChek®, UBC® Rapid Test, CancerCheck® UBC® rapid VISUAL, and cytology were 62.4%, 13.4%, 58.2%, 28.6%, 36.2% for low-grade, 83.4%, 49.5%, 84.5%, 63.1%, 71.2% for high-grade nonmuscle invasive, and 95.8%, 35.2%, 76.1%, 50.7%, 67.7% for high-grade muscle-invasive bladder cancer. The specificity was 67.9%, 95.5%, 79.4%, 94.4%, and 83.7%, respectively. The area under the curve (AUC) after receiver operating characteristics (ROC) analysis for high-grade non-muscle-invasive tumors was 0.757, 0.725, 0.819, 0.787, and 0.774, respectively. CONCLUSIONS The analysis of more than 700 urine samples offers an objective view on urine-based rapid diagnostics. Elevated pathological concentrations of markers in urine of bladder cancer patients were detected in all investigated tests. The highest sensitivities for high-grade non-muscle-invasive tumors were calculated for BTA stat® and UBC® Rapid Test, whereas NMP22® BladderChek®, and cytology showed the highest specificities. BTA stat® and UBC® Rapid Test have the potential to be used as a clinical valuable urinary protein biomarker for the detection of high-grade non-muscle-invasive bladder cancer patients and could be included in the management of these tumors.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany; Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christina J Meisl
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Lilli Sommerfeldt
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nella Gagel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Andreas Gössl
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Dimitri Barski
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, Neuss, Germany; University Hospital Essen, Essen, Germany
| | - Camilla M Grunewald
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Mario W Kramer
- Department of Urology, University Hospital Lübeck, Lübeck, Germany
| | - Stefan Koch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany; Brandenburg Medical School, Brandenburg, Germany
| | - Jenny Roggisch
- Helios Hospital, Institute of Pathology, Bad Saarow, Germany
| | | | - Sarah Weiß
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Johannes Graff
- Department of Urology, St. Elisabeth Hospital, Cologne, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | | | - Roland Hake
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
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Fiorentino V, Pizzimenti C, Franchina M, Rossi ED, Tralongo P, Carlino A, Larocca LM, Martini M, Fadda G, Pierconti F. Bladder Epicheck Test: A Novel Tool to Support Urothelial Carcinoma Diagnosis in Urine Samples. Int J Mol Sci 2023; 24:12489. [PMID: 37569864 PMCID: PMC10420163 DOI: 10.3390/ijms241512489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
Bladder cancer and upper urothelial tract carcinoma are common diseases with a high risk of recurrence, thus necessitating follow-up after initial treatment. The management of non-muscle invasive bladder carcinoma (NMIBC) after transurethral resection involves surveillance, intravesical therapy, and cytology with cystoscopy. Urinary cytology, cystoscopy, and radiological evaluation of the upper urinary tract are recommended during follow-up in the international urological guidelines. Cystoscopy is the standard examination for the first assessment and follow-up of NMIBC, and urine cytology is a widely used urinary test with high sensitivity for high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). In recent years, various urinary assays, including DNA methylation markers, have been used to detect bladder tumors. Among these, the Bladder EpiCheck test is one of the most widely used and is based on analysis of the methylation profile of urothelial cells to detect bladder neoplasms. This review assesses the importance of methylation analysis and the Bladder EpiCheck test as urinary biomarkers for diagnosing urothelial carcinomas in patients in follow-up for NMIBC, helping cytology and cystoscopy in doubtful cases. A combined approach of cytology and methylation analysis is suggested not only to diagnose HGUC, but also to predict clinical and histological recurrences.
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Affiliation(s)
- Vincenzo Fiorentino
- Department of Human Pathology of the Adult and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (M.F.); (G.F.)
| | - Cristina Pizzimenti
- PhD Programme in Translational Molecular Medicine and Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy;
| | - Mariausilia Franchina
- Department of Human Pathology of the Adult and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (M.F.); (G.F.)
| | - Esther Diana Rossi
- Department of Women, Children and Public Health Sciences, Catholic University of the Sacred Heart, Agostino Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy; (E.D.R.); (P.T.); (A.C.); (F.P.)
| | - Pietro Tralongo
- Department of Women, Children and Public Health Sciences, Catholic University of the Sacred Heart, Agostino Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy; (E.D.R.); (P.T.); (A.C.); (F.P.)
| | - Angela Carlino
- Department of Women, Children and Public Health Sciences, Catholic University of the Sacred Heart, Agostino Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy; (E.D.R.); (P.T.); (A.C.); (F.P.)
| | - Luigi Maria Larocca
- Department of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences (UniCamillus), 00131 Rome, Italy;
| | - Maurizio Martini
- Department of Human Pathology of the Adult and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (M.F.); (G.F.)
| | - Guido Fadda
- Department of Human Pathology of the Adult and Developmental Age “G. Barresi”, University of Messina, 98125 Messina, Italy; (M.F.); (G.F.)
| | - Francesco Pierconti
- Department of Women, Children and Public Health Sciences, Catholic University of the Sacred Heart, Agostino Gemelli IRCCS University Hospital Foundation, 00168 Rome, Italy; (E.D.R.); (P.T.); (A.C.); (F.P.)
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Zang Z, Kesavan NR, Esuvaranathan K. UBC®Rapid Is Sensitive in Detecting High-Grade Bladder Urothelial Carcinoma and Carcinoma in situ in Asian Population. Urol Int 2023; 107:29-34. [PMID: 36273445 PMCID: PMC9909706 DOI: 10.1159/000526763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/06/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Bladder cancer is a common type of malignancy. UBC®Rapid is a novel immunoassay detecting urine cytokeratin 8/18 protein. Studies have shown good accuracy of UBC®Rapid in detecting bladder cancer. UBC®Rapid has however to date not been evaluated in Asian patients. We evaluated UBC®Rapid in detecting Asian bladder cancer, together with urine cytology. METHODS In total, 112 patients were recruited from National University Hospital Singapore and 103 patients were included in this study, comprising 49 patients with bladder urothelial carcinoma (UC), 21 patients with bladder benign lesions, and 33 patients with normal bladder. All the bladder cancer and benign lesions were confirmed by histology. Voided urine was collected for UBC®Rapid test. The results were compared with urine cytology. RESULTS The bladder UC group had remarkably higher UBC®Rapid value than the control groups. The sensitivity, specificity, positive, and negative predictive value of UBC®Rapid in detecting bladder UC were 53%, 85.5%, 76.5%, and 66.8%, respectively. Those of urine cytology were 40.8%, 96.3%, 90.9%, and 64.2%, respectively. Adding UBC®Rapid to urine cytology increased sensitivity to 57.1% but decreased specificity to 81.8%. UBC®Rapid was sensitive in detecting high-grade bladder UC (61.1%) and carcinoma in situ (CIS) (72.7%), as compared to urine cytology for bladder UC (55.6%) and CIS (54.5%), respectively. CONCLUSION UBC®Rapid is sensitive in detecting high-grade bladder UC and CIS in Asian population. It may be useful as an adjunct test to achieve better detection of bladder cancer.
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Affiliation(s)
- Zhijiang Zang
- Department of Urology, National University Health System, Singapore, Singapore,*Zhijiang Zang,
| | | | - Kesavan Esuvaranathan
- Department of Urology, National University Health System, Singapore, Singapore,Department of Surgery, Yong Loo Lin School of Medicine, Singapore, Singapore
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5
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Quantitative detection of urinary bladder cancer antigen via peptide-immobilized magnetic bead-based SERS probe. Anal Bioanal Chem 2022; 414:8289-8297. [DOI: 10.1007/s00216-022-04361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/18/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022]
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Proteomics for Early Detection of Non-Muscle-Invasive Bladder Cancer: Clinically Useful Urine Protein Biomarkers. Life (Basel) 2022; 12:life12030395. [PMID: 35330146 PMCID: PMC8950253 DOI: 10.3390/life12030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Bladder cancer is the fourth most common cancer in men, and most cases are non-muscle-invasive. A high recurrence rate is a critical problem in non-muscle-invasive bladder cancer. The availability of few urine tests hinders the effective detection of superficial and small bladder tumors. Cystoscopy is the gold standard for diagnosis; however, it is associated with urinary tract infections, hematuria, and pain. Early detection is imperative, as intervention influences recurrence. Therefore, urinary biomarkers need to be developed to detect these bladder cancers. Recently, several protein candidates in the urine have been identified as biomarkers. In the present narrative review, the current status of the development of urinary protein biomarkers, including FDA-approved biomarkers, is summarized. Additionally, contemporary proteomic technologies, such as antibody-based methods, mass-spectrometry-based methods, and machine-learning-based diagnosis, are reported. Furthermore, new strategies for the rapid and correct profiling of potential biomarkers of bladder cancer in urine are introduced, along with their limitations. The advantages of urinary protein biomarkers and the development of several related technologies are highlighted in this review. Moreover, an in-depth understanding of the scientific background and available protocols in research and clinical applications of the surveillance of non-muscle bladder cancer is provided.
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Meisl CJ, Karakiewicz PI, Einarsson R, Koch S, Hallmann S, Weiß S, Hemdan T, Malmström P, Styrke J, Sherif A, Hasan MN, Pichler R, Tulchiner G, Palou J, Rodríguez Faba Ó, Hennenlotter J, Stenzl A, Ritter R, Niegisch G, Grunewald CM, Schlomm T, Friedersdorff F, Barski D, Otto T, Gössl A, Arndt C, Esuvaranathan K, Kesavan NR, Zhijiang Z, Kramer MW, Hennig MJ, Ecke TH. Nomograms including UBC® Rapid Test to detect primary bladder cancer based on a multicenter data set. BJU Int 2021; 130:754-763. [DOI: 10.1111/bju.15677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Christina J. Meisl
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
| | | | | | - Stefan Koch
- Dept. of Pathology HELIOS Hospital Bad Saarow Bad Saarow Germany
- Brandenburg Medical School Theodor Fontane Neuruppin Germany
| | | | - Sarah Weiß
- Dept. of Urology HELIOS Hospital Bad Saarow Bad Saarow Germany
| | - Tammer Hemdan
- Dept. of Surgical Sciences Uppsala University Uppsala Sweden
| | | | - Johan Styrke
- Dept. of Surgical and Perioperative Sciences, Urology and Andrology Umeå University Umeå Sweden
| | - Amir Sherif
- Dept. of Surgical and Perioperative Sciences, Urology and Andrology Umeå University Umeå Sweden
| | | | - Renate Pichler
- Dept. of Urology Medical University Innsbruck Innsbruck Austria
| | | | - Joan Palou
- Dept. of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
| | - Óscar Rodríguez Faba
- Dept. of Urology Fundació Puigvert Autonomous University of Barcelona Barcelona Spain
| | - Jörg Hennenlotter
- Dept. of Urology University Hospital Faculty of Medicine Tübingen Tübingen Germany
| | - Arnulf Stenzl
- Dept. of Urology University Hospital Faculty of Medicine Tübingen Tübingen Germany
| | - René Ritter
- Dept. of Urology Diakonie‐Klinikum Stuttgart Stuttgart Germany
| | - Günter Niegisch
- Dept. of Urology Medical Faculty Heinrich‐Heine University Düsseldorf Düsseldorf Germany
| | - Camilla M. Grunewald
- Dept. of Urology Medical Faculty Heinrich‐Heine University Düsseldorf Düsseldorf Germany
| | - Thorsten Schlomm
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
| | - Frank Friedersdorff
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
- Dept. of Urology Evangelisches Krankenhaus Königin Elisabeth Herzberge Berlin Germany
| | | | - Thomas Otto
- Dept. of Urology Rheinland Klinikum Neuss Neuss Germany
- Medical Faculty University of Duisburg‐Essen Essen Germany
| | - Andreas Gössl
- Dept. of Urology HELIOS Hospital Krefeld Krefeld Germany
| | | | | | - Nisha R. Kesavan
- Dept. of Urology National University Hospital Singapore City Singapore
| | - Zang Zhijiang
- Dept. of Urology National University Hospital Singapore City Singapore
| | - Mario W. Kramer
- Dept. of Urology University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Martin J.P. Hennig
- Dept. of Urology University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - Thorsten H. Ecke
- Dept. of Urology Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humbold‐Universität zu Berlin Berlin Institute of Health Berlin Germany
- Dept. of Urology HELIOS Hospital Bad Saarow Bad Saarow Germany
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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.
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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
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9
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Dardeer KT, Mohammed KA, Hussein TD, Elsheemy MS. Apolipoprotein A1 as a novel urinary biomarker for diagnosis of bladder cancer: A systematic review and meta-analysis. Indian J Urol 2021; 37:217-225. [PMID: 34465950 PMCID: PMC8388338 DOI: 10.4103/iju.iju_69_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/17/2021] [Accepted: 05/27/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction: The emergence of urinary biomarkers for bladder cancer diagnosis could provide a reliable and less invasive diagnostic method. It could be also used as an adjuvant to the current gold standards of cytology and cystoscopy to improve diagnostic accuracy and decrease the percentage of false positives. Methods: We searched PubMed, SCOPUS, and Web of Science up to March 18, 2020. We selected four studies that assessed the diagnostic accuracy of urinary apolipoprotein A1 (ApoA-1) in detecting bladder cancer and met the inclusion and exclusion criteria. Two authors independently extracted the data and performed quality assessment of the studies. Results: Four studies with 771 participants were selected; 417 were bladder cancer patients and 354 were controls. Bladder cancer was either transitional cell carcinoma or squamous cell carcinoma, the stages varied between Ta to T3, and the grades varied between G1 and G3. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 90.7%, 90%, 9.478, 0.1, and 99.424, respectively. Summary receiver operating characteristic curve showed an area under the curve of 0.9544 and Q* index of 0.8965. Conclusions: ApoA-1 showed high sensitivity and specificity, so it could be a useful biomarker in diagnosis of bladder cancer.
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10
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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.
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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.
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11
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Humayun-Zakaria N, Ward DG, Arnold R, Bryan RT. Trends in urine biomarker discovery for urothelial bladder cancer: DNA, RNA, or protein? Transl Androl Urol 2021; 10:2787-2808. [PMID: 34295762 PMCID: PMC8261432 DOI: 10.21037/tau-20-1327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/23/2021] [Indexed: 02/01/2023] Open
Abstract
Urothelial bladder cancer is a complex disease displaying a landscape of heterogenous molecular subtypes, mutation profiles and clinical presentations. Diagnosis and surveillance rely on flexible cystoscopy which has high accuracy, albeit accompanied by a high-cost burden for healthcare providers and discomfort for patients. Advances in "omic" technologies and computational biology have provided insights into the molecular pathogenesis of bladder cancer and provided powerful tools to identify markers for disease detection, risk stratification, and predicting responses to therapy. To date, numerous attempts have been made to discover and validate diagnostic biomarkers that could be deployed as an adjunct to the cystoscopic diagnosis and long-term surveillance of bladder cancer. We report a comprehensive literature analysis using PubMed to assess the changing trends in investigating DNA, RNA, or proteins as diagnostic urinary biomarkers over a period of 5 decades: 1970-2020. A gradual shift has been observed in research away from protein biomarkers to nucleic acids including different classes of RNA, and DNA methylation and mutation markers. Until 2000, publications involving protein biomarker discovery constituted 87% of the total number of research articles with DNA comprising 6% and RNA 7%. Since 2000 the proportion of protein biomarker articles has fallen to 40%, and DNA and RNA studies increased to 32% and 28%, respectively. Clearly research focus, perhaps driven by technological innovation, has shifted from proteins to nucleic acids. We optimistically hypothesise that, following thorough validation, a clinically useful detection test for bladder cancer based on a panel of DNA or RNA markers could become reality within 5-10 years.
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Affiliation(s)
- Nada Humayun-Zakaria
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Douglas G Ward
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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12
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Vasdev N, Hampson A, Agarwal S, Swamy R, Chilvers M, Hampson A, Jahanfard S, Kim N. The role of URO17™ biomarker to enhance diagnosis of urothelial cancer in new hematuria patients—First European Data. BJUI COMPASS 2020; 2:46-52. [PMID: 35474659 PMCID: PMC8988772 DOI: 10.1002/bco2.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction and objectives Novel biomarker research is vital for the progression of safe and thorough diagnostic medicine. There is now a need to improve the diagnosis of bladder cancer via a noninvasive urine test while balancing the risks of harm from investigational procedures, such as cystoscopy and radiological tests, against the likelihood of malignancy. We evaluate the diagnostic accuracy and sensitivity of Uro17™ urinary biomarker for the detection of urothelial cancer in hematuria patients in a prospective blinded validation study. Uro17™ is an immunobiomarker which binds to the oncoprotein Keratin 17, which is involved in the replication cycle of malignant cells. This study compared cystoscopic and histological investigations against Uro17™ results in patients being investigated for symptoms of urothelial cancer. Materials and methods After receiving both local and national ethics/protocol approval, 71 patients were consented and recruited into the study. All patients were scheduled to undergo cystoscopic investigation, and following recruitment, a urine sample was collected. Urine samples were anonymized and processed as per standard cytology protocols and stained using Uro17™ immunobiomarker. The pathologists assessing the results were blinded to the patient and background history, and the results were compared to the biopsy histology. Results The full cohort of enrolled patients consisted of 71 participants included. There were 55 males and 16 females, with an average age of 70. Thirteen were current smokers, 42 ex‐smokers, and 16 nonsmokers. The malignancies detected included both muscle‐invasive (n = 6) and non‐muscle‐invasive tumors (n = 38), and tumors of all grades and carcinoma in situ. Uro17™ was shown to have an overall sensitivity of 100% and a specificity of 92.6%, with a positive predictive value of 0.957 and negative predictive value of 1. Uro17™ investigation was positive in every case of urothelial malignancy. Conclusions Our current data indicates Uro17™ is a highly sensitive noninvasive bladder cancer urine detection test that can improve the diagnosis of Bladder cancer. This can further improve diagnostic capabilities in primary care, reduce the number of referrals to Urology department, and reduce the number of unnecessary invasive procedures for new patients with a suspected urinary bladder cancer.
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Affiliation(s)
- Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital Stevenage UK
- School of Life and Medical Sciences University of Hertfordshire Hatfield UK
| | - Alexander Hampson
- Hertfordshire and Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital Stevenage UK
| | | | - Rajiv Swamy
- Department of Pathology Lister Hospital Stevenage UK
| | | | - Amy Hampson
- Hertfordshire and Bedfordshire Urological Cancer Centre Department of Urology Lister Hospital Stevenage UK
| | | | - Nam Kim
- KDx Diagnostics Inc Campbell CA USA
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13
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Zvereva M, Pisarev E, Hosen I, Kisil O, Matskeplishvili S, Kubareva E, Kamalov D, Tivtikyan A, Manel A, Vian E, Kamalov A, Ecke T, Calvez-Kelm FL. Activating Telomerase TERT Promoter Mutations and Their Application for the Detection of Bladder Cancer. Int J Mol Sci 2020; 21:E6034. [PMID: 32839402 PMCID: PMC7503716 DOI: 10.3390/ijms21176034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
This review summarizes state-of-the-art knowledge in early-generation and novel urine biomarkers targeting the telomerase pathway for the detection and follow-up of bladder cancer (BC). The limitations of the assays detecting telomerase reactivation are discussed and the potential of transcription-activating mutations in the promoter of the TERT gene detected in the urine as promising simple non-invasive BC biomarkers is highlighted. Studies have shown good sensitivity and specificity of the urinary TERT promoter mutations in case-control studies and, more recently, in a pilot prospective cohort study, where the marker was detected up to 10 years prior to clinical diagnosis. However, large prospective cohort studies and intervention studies are required to fully validate their robustness and assess their clinical utility. Furthermore, it may be interesting to evaluate whether the clinical performance of urinary TERT promoter mutations could increase when combined with other simple urinary biomarkers. Finally, different approaches for assessment of TERT promoter mutations in urine samples are presented together with technical challenges, thus highlighting the need of careful technological validation and standardization of laboratory methods prior to translation into clinical practice.
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Affiliation(s)
- Maria Zvereva
- Chair of Chemistry of Natural Compounds, Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
- International Agency for Research on Cancer (IARC), 69372 Lyon, France;
| | - Eduard Pisarev
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Ismail Hosen
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Dhaka, Dhaka 1000, Bangladesh;
| | - Olga Kisil
- Gause Institute of New Antibiotics, 119021 Moscow, Russia;
| | - Simon Matskeplishvili
- Medical Research and Education Center, Lomonosov Moscow State University, 119992 Moscow, Russia; (S.M.); (D.K.); (A.T.); (A.K.)
| | - Elena Kubareva
- Belozersky Institute of Physico-Chemical Biology, Moscow State University, 119992 Moscow, Russia;
| | - David Kamalov
- Medical Research and Education Center, Lomonosov Moscow State University, 119992 Moscow, Russia; (S.M.); (D.K.); (A.T.); (A.K.)
| | - Alexander Tivtikyan
- Medical Research and Education Center, Lomonosov Moscow State University, 119992 Moscow, Russia; (S.M.); (D.K.); (A.T.); (A.K.)
| | | | - Emmanuel Vian
- Department of Urology, Protestant Clinic of Lyon, 69300 Lyon, France;
| | - Armais Kamalov
- Medical Research and Education Center, Lomonosov Moscow State University, 119992 Moscow, Russia; (S.M.); (D.K.); (A.T.); (A.K.)
| | - Thorsten Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, D-15526 Bad Saarow, Germany;
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14
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Oehr P, Ecke T. Establishment and Characterization of an Empirical Biomarker SS/PV-ROC Plot Using Results of the UBC ® Rapid Test in Bladder Cancer. ENTROPY (BASEL, SWITZERLAND) 2020; 22:e22070729. [PMID: 33286501 PMCID: PMC7517270 DOI: 10.3390/e22070729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND This investigation included both a study of potential non-invasive diagnostic approaches for the bladder cancer biomarker UBC® Rapid Test and a study including comparative methods about sensitivity-specificity characteristic (SS-ROC) and predictive receiver operating characteristic (PV-ROC) curves that used bladder cancer as a useful example. METHODS The study included 289 urine samples from patients with tumors of the urinary bladder, patients with non-evidence of disease (NED) and healthy controls. The UBC® Rapid Test is a qualitative point of care assay. Using a photometric reader, quantitative data can also be obtained. Data for pairs of sensitivity/specificity as well as positive/negative predictive values were created by variation of threshold values for the whole patient cohort, as well as for the tumor-free control group. Based on these data, sensitivity-specificity and predictive value threshold distribution curves were constructed and transformed into SS-ROC and PV-ROC curves, which were included in a single SS/PV-ROC plot. RESULTS The curves revealed TPP-asymmetric improper curves which cross the diagonal from above. Evaluation of the PV-ROC curve showed that two or more distinct positive predictive values (PPV) can correspond to the same value of a negative predictive value (NPV) and vice versa, indicating a complexity in PV-ROC curves which did not exist in SS-ROC curves. In contrast to the SS-ROC curve, the PV-ROC curve had neither an area under the curve (AUC) nor a range from 0% to 100%. Sensitivity of the qualitative assay was 58.5% and specificity 88.2%, PPV was 75.6% and NPV 77.3%, at a threshold value of approximately 12.5 µg/L. CONCLUSIONS The SS/PV-ROC plot is a new diagnostic approach which can be used for direct judgement of gain and loss of predictive values, sensitivity and specificity according to varied threshold value changes, enabling characterization, comparison and evaluation of qualitative and quantitative bioassays.
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Affiliation(s)
- Peter Oehr
- Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität Bonn, 53113 Bonn, Germany
| | - Thorsten Ecke
- Department of Urology, HELIOS Hospital, 15526 Bad Saarow, Germany
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15
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Benderska-Söder N, Hovanec J, Pesch B, Goebell PJ, Roghmann F, Noldus J, Rabinovich J, Wichert K, Gleichenhagen J, Käfferlein HU, Köhler CU, Johnen G, Kernig K, Hakenberg O, Jahn D, Todenhöfer T, Stenzl A, Gleissner J, Gerwert K, El-Mashtoly S, Behrens T, Brüning T, Schmitz-Dräger BJ. Toward noninvasive follow-up of low-risk bladder cancer - Rationale and concept of the UroFollow trial. Urol Oncol 2020; 38:886-895. [PMID: 32199755 DOI: 10.1016/j.urolonc.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Follow-up recommendations for patients with nonmuscle invasive bladder cancer (NMIBC) are largely based upon expert opinion. A growing body of evidence suggests that current follow-up strategies for bladder cancer patients with low and intermediate risk represent overdiagnosis and may lead to overtreatment. The goal of this study is to explore the options of a noninvasive follow-up in patients with pTa G1-2/low-grade NMIBC. METHODS The risks and options for a urine marker-guided, noninvasive follow-up of patients with pTa G1-2/low-grade NMIBC were defined and the study design for a prospective randomized trial (UroFollow) was developed based upon the current literature. RESULTS The investigators postulated that follow-up of patients with pTa G1-2/low-grade NMIBC requires a high sensitivity of urinary tumor markers. However, data from prospective studies with prediagnostic urine samples are scarce, even for approved markers, and cross-sectional studies with symptomatic patients overestimate the sensitivity. So far, cell-based markers (e.g., uCyt+ and UroVysion) in urine appeared to have higher sensitivities and specificities in low-grade NMIBC than urine cytology and markers analyzing soluble tumor-associated antigens. Marker panels are more sensitive than single-marker approaches at the expense of a lower specificity. Given a prospective randomized comparison with a marker sensitivity of 80% compared to usual care with cystoscopy, the sample size calculation yielded that 62 to 185 patients under study per arm are needed depending on different recurrence rates. CONCLUSIONS Based upon these findings the UroFollow trial has been designed as a prospective randomized study comparing a noninvasive marker-based (UroVysion, NMP22, urine cytology, and ultrasound) follow-up with the current standard of care over a period of 3 years.
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Affiliation(s)
| | - Jan Hovanec
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| | | | - Katharina Wichert
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Jan Gleichenhagen
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Heiko U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Christina U Köhler
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Karoline Kernig
- Department of Urology, University of Rostock, Rostock, Germany
| | | | - Daniela Jahn
- Department of Urology, University of Rostock, Rostock, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | | | - Klaus Gerwert
- Ruhr University Bochum, Faculty of Biology and Biotechnology, Department of Biophysics, Bochum, Germany; Ruhr University Bochum, Center for Protein Diagnostics (ProDi), Biospectroscopy, Bochum, Germany
| | - Samir El-Mashtoly
- Ruhr University Bochum, Faculty of Biology and Biotechnology, Department of Biophysics, Bochum, Germany; Ruhr University Bochum, Center for Protein Diagnostics (ProDi), Biospectroscopy, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accidence Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nürnberg, Germany; Department of Urology, Friedrich-Alexander University, Erlangen, Germany.
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16
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Ecke TH, Otto T. Illumination of a Vision 2020-Urinary Based Biomarkers for Bladder Cancer on the Way to Clinical Decisions-Dream or Nightmare? Int J Mol Sci 2020; 21:ijms21051694. [PMID: 32121621 PMCID: PMC7084301 DOI: 10.3390/ijms21051694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, D-15526 Bad Saarow, Germany
- Correspondence: (T.H.E.); (T.O.)
| | - Thomas Otto
- Department of Urology, Lukaskrankenhaus Neuss, D-41464 Neuss, Germany
- University Hospital Essen, D-45147 Essen, Germany
- Correspondence: (T.H.E.); (T.O.)
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17
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Rose M, Bringezu S, Godfrey L, Fiedler D, Gaisa NT, Koch M, Bach C, Füssel S, Herr A, Hübner D, Ellinger J, Pfister D, Knüchel R, Wirth MP, Böhme M, Dahl E. ITIH5 and ECRG4 DNA Methylation Biomarker Test (EI-BLA) for Urine-Based Non-Invasive Detection of Bladder Cancer. Int J Mol Sci 2020; 21:ijms21031117. [PMID: 32046186 PMCID: PMC7036997 DOI: 10.3390/ijms21031117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023] Open
Abstract
Bladder cancer is one of the more common malignancies in humans and the most expensive tumor for treating in the Unites States (US) and Europe due to the need for lifelong surveillance. Non-invasive tests approved by the FDA have not been widely adopted in routine diagnosis so far. Therefore, we aimed to characterize the two putative tumor suppressor genes ECRG4 and ITIH5 as novel urinary DNA methylation biomarkers that are suitable for non-invasive detection of bladder cancer. While assessing the analytical performance, a spiking experiment was performed by determining the limit of RT112 tumor cell detection (range: 100-10,000 cells) in the urine of healthy donors in dependency of the processing protocols of the RWTH cBMB. Clinically, urine sediments of 474 patients were analyzed by using quantitative methylation-specific PCR (qMSP) and Methylation Sensitive Restriction Enzyme (MSRE) qPCR techniques. Overall, ECRG4-ITIH5 showed a sensitivity of 64% to 70% with a specificity ranging between 80% and 92%, i.e., discriminating healthy, benign lesions, and/or inflammatory diseases from bladder tumors. When comparing single biomarkers, ECRG4 achieved a sensitivity of 73%, which was increased by combination with the known biomarker candidate NID2 up to 76% at a specificity of 97%. Hence, ITIH5 and, in particular, ECRG4 might be promising candidates for further optimizing current bladder cancer biomarker panels and platforms.
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Affiliation(s)
- Michael Rose
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
- RWTH Centralized Biomaterial Bank (RWTH cBMB), Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Correspondence: (M.R.); (E.D.); Tel.: +49-241-808-9715 (M.R.); +49-241-808-8431 (E.D.); Fax: +49-241-808-2439 (M.R.); +49-241-808-2439 (E.D.)
| | - Sarah Bringezu
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - Laura Godfrey
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - David Fiedler
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - Nadine T. Gaisa
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - Maximilian Koch
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - Christian Bach
- Department of Urology, RWTH Aachen University, 52074 Aachen, Germany; (C.B.); (D.P.)
| | - Susanne Füssel
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (D.H.); (M.P.W.)
| | | | - Doreen Hübner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (D.H.); (M.P.W.)
| | - Jörg Ellinger
- Department of Urology, University Hospital Bonn, 53105 Bonn, Germany;
| | - David Pfister
- Department of Urology, RWTH Aachen University, 52074 Aachen, Germany; (C.B.); (D.P.)
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Ruth Knüchel
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
| | - Manfred P. Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (D.H.); (M.P.W.)
| | - Manja Böhme
- Biotype GmbH, 01109 Dresden, Germany; (A.H.); (M.B.)
| | - Edgar Dahl
- Institute of Pathology, RWTH Aachen University, 52074 Aachen, Germany; (S.B.); (L.G.); (D.F.); (N.T.G.); (M.K.); (R.K.)
- RWTH Centralized Biomaterial Bank (RWTH cBMB), Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Correspondence: (M.R.); (E.D.); Tel.: +49-241-808-9715 (M.R.); +49-241-808-8431 (E.D.); Fax: +49-241-808-2439 (M.R.); +49-241-808-2439 (E.D.)
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18
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Lang K, Kahveci S, Bonberg N, Wichert K, Behrens T, Hovanec J, Roghmann F, Noldus J, Tam YC, Tannapfel A, Käfferlein HU, Brüning T. TGFBI Protein Is Increased in the Urine of Patients with High-Grade Urothelial Carcinomas, and Promotes Cell Proliferation and Migration. Int J Mol Sci 2019; 20:ijms20184483. [PMID: 31514337 PMCID: PMC6770034 DOI: 10.3390/ijms20184483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023] Open
Abstract
Here, we discovered TGFBI as a new urinary biomarker for muscle invasive and high-grade urothelial carcinoma (UC). After biomarker identification using antibody arrays, results were verified in urine samples from a study population consisting of 303 patients with UC, and 128 urological and 58 population controls. The analyses of possible modifying factors (age, sex, smoking status, urinary leukocytes and erythrocytes, and history of UC) were calculated by multiple logistic regression. Additionally, we performed knockdown experiments with TGFBI siRNA in bladder cancer cells and investigated the effects on proliferation and migration by wound closure assays and BrdU cell cycle analysis. TGFBI concentrations in urine are generally increased in patients with UC when compared to urological and population controls (1321.0 versus 701.3 and 475.6 pg/mg creatinine, respectively). However, significantly increased TGFBI was predominantly found in muscle invasive (14,411.7 pg/mg creatinine), high-grade (8190.7 pg/mg) and de novo UC (1856.7 pg/mg; all p < 0.0001). Knockdown experiments in vitro led to a significant decline of cell proliferation and migration. In summary, our results suggest a critical role of TGFBI in UC tumorigenesis and particularly in high-risk UC patients with poor prognosis and an elevated risk of progression on the molecular level.
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Affiliation(s)
- Kerstin Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Selcan Kahveci
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Nadine Bonberg
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Katharina Wichert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Jan Hovanec
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Hölkeskampring 40, 44625 Herne, Germany.
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Hölkeskampring 40, 44625 Herne, Germany.
| | - Yu Chun Tam
- Institute of Pathology, Georgius Agricola Stiftung Ruhr, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Andrea Tannapfel
- Institute of Pathology, Georgius Agricola Stiftung Ruhr, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Heiko U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
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