Burchardt M, Burchardt T, Shabsigh A, De La Taille A, Benson M C, Sawczuk I
Department of Urology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
Clin Chem. 2000 May;46(5):595-605.
Transitional cell carcinoma of the bladder (TCC) is the second most common malignancy of the urinary tract. More than 70% of treated tumors recur, and 30% of recurrent tumors progress. Currently, pathologic staging and grading are valuable prognostic factors for detecting and monitoring TCC. Urinalysis, cystoscopy, and cytology are either invasive or lack sensitivity and specificity. The availability of a noninvasive, reliable, and simple test would greatly improve the detection and monitoring of patients with TCC. Several biomarkers for bladder cancer have been proposed, but no single marker has emerged as the test of choice.
We undertook a comprehensive literature search using Medline to identify all publications from 1980 to 1999. Articles that discussed potential biomarkers for TCC were screened. Only compounds that demonstrated high sensitivity or specificity, significant correlation with TCC diagnosis and staging, and extensive investigation were included in this review.
Potential biomarkers of disease progression and prognosis include nuclear matrix protein, fibrin/fibrinogen product, bladder tumor antigen, blood group-related antigens, tumor-associated antigens, proliferating antigens, oncogenes, growth factors, cell adhesion molecules, and cell cycle regulatory proteins. The properties of the biomarkers and the methods for detecting or quantifying them are presented. Their sensitivities and specificities for detecting and monitoring disease were 54-100% and 61-97%, respectively, compared with 20-40% and 90% for urinalysis and cytology.
Although urine cytology and cystoscopy are still the standard of practice, many candidate biomarkers for TCC are emerging and being adopted into clinical practice. Further research and better understanding of the biology of bladder cancer, improved diagnostic techniques, and standardized interpretation are essential steps to develop reliable biomarkers. It is possible that using the current biomarkers as an adjuvant modality will improve our ability to diagnose and monitor bladder cancer.
膀胱移行细胞癌（TCC）是泌尿道第二常见的恶性肿瘤。超过70%的经治疗肿瘤会复发，30%的复发性肿瘤会进展。目前，病理分期和分级是检测和监测TCC的重要预后因素。尿液分析、膀胱镜检查和细胞学检查要么具有侵入性，要么缺乏敏感性和特异性。一种非侵入性、可靠且简单的检测方法的出现将极大地改善对TCC患者的检测和监测。已经提出了几种膀胱癌生物标志物，但尚未有一种单一标志物成为首选检测方法。
我们使用Medline进行了全面的文献检索，以识别1980年至1999年的所有出版物。筛选了讨论TCC潜在生物标志物的文章。本综述仅纳入了那些显示出高敏感性或特异性、与TCC诊断和分期有显著相关性且经过广泛研究的化合物。
疾病进展和预后的潜在生物标志物包括核基质蛋白、纤维蛋白/纤维蛋白原产物、膀胱肿瘤抗原、血型相关抗原、肿瘤相关抗原、增殖抗原、癌基因、生长因子、细胞粘附分子和细胞周期调节蛋白。介绍了生物标志物的特性以及检测或定量它们的方法。与尿液分析和细胞学检查分别为20 - 40%和90%相比，它们检测和监测疾病的敏感性和特异性分别为54 - 100%和61 - 97%。
尽管尿液细胞学检查和膀胱镜检查仍是标准做法，但许多TCC候选生物标志物正在涌现并被应用于临床实践。进一步的研究、对膀胱癌生物学的更好理解、改进的诊断技术以及标准化的解释是开发可靠生物标志物的关键步骤。将当前生物标志物用作辅助手段有可能提高我们诊断和监测膀胱癌的能力。
