Ichikawa T, Nakayama Y, Yamada D, Saegusa M, Asano S, Aramaki K
Department of Urology, Hiroshima City Hospital.
Nihon Hinyokika Gakkai Zasshi. 2000 Jul-Aug;91(7-8):579-83. doi: 10.5980/jpnjurol1989.91.579.
The early diagnosis of bladder cancer allows for effective local treatment and optimizes the success of surgical therapy. Basic fetoprotein (BFP), measured using a rapid latex immuno-agglutination method, was introduced for the detection of transitional cell carcinoma. The objective of this study was to determine whether there was a correlation between urine BFP level and the grade or stage of bladder cancer, and whether the level could serve as a biochemical marker of bladder cancer.
Single voided specimens were obtained from 66 patients with confirmed or suspicious bladder cancer on cystoscopy, urine cytology or BFP. Each sample was divided into 3 aliquots of which 1 was for urine analysis, 1 was tested for BFP according to latex immunoagglutination method and 1 was sent for cytological examination. All patients subsequently underwent bladder biopsy.
There were 54 (82%) patients with biopsy confirmed bladder cancer and 12 (18%) with benign conditions of the bladder. Overall sensitivity with BFP and urine cytology was 38.9% and 48.1% respectively. Specificity was 58.3% and 75.0%, and positive predictive value was 80.8% and 89.7%, respectively. The positive rate of BFP and cytology was higher in invasive cancer (75% and 100%, respectively) than in superficial cancer (36% and 28%). There was no correlation between BFP level and tumor grade, while cytology had a strong association. Linear regression analysis showed the significant correlation between BFP level and tumor size (r = 0.695, p < 0.0001). The detection rate of bladder cancer was higher by the combination of BFP and cytology than by using alone.
BFP in conjunction with urine cytology can increase the detection rate of bladder cancer. But BFP alone cannot be used as a screening test for bladder cancer.
膀胱癌的早期诊断有助于进行有效的局部治疗，并优化手术治疗的成功率。采用快速乳胶免疫凝集法检测的基础甲胎蛋白（BFP）被用于检测移行细胞癌。本研究的目的是确定尿BFP水平与膀胱癌分级或分期之间是否存在相关性，以及该水平是否可作为膀胱癌的生化标志物。
从66例经膀胱镜检查、尿细胞学检查或BFP检查确诊或疑似膀胱癌的患者中获取单次排尿标本。每个样本分为3份，1份用于尿液分析，1份根据乳胶免疫凝集法检测BFP，1份送去做细胞学检查。所有患者随后均接受膀胱活检。
54例（82%）患者经活检确诊为膀胱癌，12例（18%）为膀胱良性疾病。BFP和尿细胞学检查的总体敏感性分别为38.9%和48.1%。特异性分别为58.3%和75.0%，阳性预测值分别为80.8%和89.7%。浸润性癌中BFP和细胞学检查的阳性率（分别为75%和100%）高于浅表性癌（分别为36%和28%）。BFP水平与肿瘤分级之间无相关性，而细胞学检查有很强的相关性。线性回归分析显示BFP水平与肿瘤大小之间存在显著相关性（r = 0.695，p < 0.0001）。BFP与细胞学检查联合检测膀胱癌的检出率高于单独使用。
BFP联合尿细胞学检查可提高膀胱癌的检出率。但单独使用BFP不能作为膀胱癌的筛查试验。
