Ozen H, Hall M C
Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Curr Opin Oncol. 2000 May;12(3):255-9. doi: 10.1097/00001622-200005000-00012.
There is a need for the development of reliable tumor markers in bladder cancer. A number of studies this past year focused on the evaluation of urinary markers that hold promise as noninvasive adjuncts to traditional diagnostic or surveillance techniques, principally urinary cytology and cystoscopy. Tests for bladder tumor antigen, NMP22, and fibrin degradation products, as well as the Immunocyt test, are commercially available. Other urinary marker tests discussed in this review include telomerase, cytokeratins, and vascular endothelial growth factor. Although these tests in many instances have improved sensitivity in detecting bladder cancer compared with urinary cytology, none have become widely accepted in routine clinical practice. Nonetheless, with further refinement and prospective validation in multicenter trials, markers such as these may provide information that would permit tailoring on an individual basis the type of as well as interval of surveillance examinations. Furthermore, they may also provide information allowing the appropriate selection of therapy based on predicted response. In addition to urinary markers, intense research efforts have also focused on developing clinically useful molecular prognostic markers. A number of cell-cycle regulatory proteins, including p53 and p21, have received much attention in this regard. Emerging data suggests that it may soon be possible to determine the molecular phenotype of both superficial and invasive bladder cancers, thereby providing information regarding tumor behavior on an individual basis. As with urinary markers, however, no molecular markers have been incorporated as yet into day-to-day patient care. Assurances of reproducibility, standardization, and prospective validation studies are urgently needed. It is only through this type of rigorous evaluation that the level of confidence sufficient to base treatment decisions on marker status will be attained.
膀胱癌领域需要开发可靠的肿瘤标志物。过去一年，多项研究聚焦于评估有望作为传统诊断或监测技术（主要是尿细胞学检查和膀胱镜检查）非侵入性辅助手段的尿液标志物。膀胱肿瘤抗原、NMP22、纤维蛋白降解产物的检测以及免疫细胞检测均有商业化产品。本综述中讨论的其他尿液标志物检测包括端粒酶、细胞角蛋白和血管内皮生长因子。尽管这些检测在许多情况下与尿细胞学检查相比提高了检测膀胱癌的敏感性，但在常规临床实践中均未被广泛接受。尽管如此，随着进一步完善并在多中心试验中进行前瞻性验证，这类标志物可能会提供信息，从而能够根据个体情况调整监测检查的类型和间隔时间。此外，它们还可能提供信息，以便根据预测反应适当选择治疗方法。除了尿液标志物，大量研究工作还集中在开发具有临床应用价值的分子预后标志物。包括p53和p21在内的多种细胞周期调节蛋白在这方面受到了广泛关注。新出现的数据表明，不久之后或许就能确定浅表性和浸润性膀胱癌的分子表型，从而为个体提供有关肿瘤行为的信息。然而，与尿液标志物一样，目前还没有分子标志物被纳入日常患者护理中。迫切需要确保可重复性、标准化以及进行前瞻性验证研究。只有通过这种严格的评估，才能获得足够的信心，以便根据标志物状态做出治疗决策。
