Shariat Shahrokh F, Casella Roberto, Khoddami Seyed M, Hernandez Gina, Sulser Tullio, Gasser Thomas C, Lerner Seth P
Scott Department of Urology, Baylor College of Medicine and The Methodist Hospital, Houston, Texas 77030, USA.
J Urol. 2004 Feb;171(2 Pt 1):626-30. doi: 10.1097/01.ju.0000107826.78479.90.
In a preliminary study urine detection of survivin, an integrator of cell death and mitosis, accurately detected bladder cancer. The objectives of this study were to confirm these findings in a large cohort of subjects undergoing cystoscopy, to assess the diagnostic performance of urine survivin and to test whether evaluation of urine survivin adds independent value to urine NMP22 (Matritech, Cambridge, Massachusetts) and cytology for the detection of bladder cancer.
Urine survivin was measured using a Bio-Dot microfiltration detection system (Bio-Rad, Hercules, California) in voided urine specimens collected before cystoscopy in 117 cases and 92 controls. Bladder washout samples for cytology were collected in 174 subjects. Urine levels of NMP22 were measured using a commercially available enzyme-linked immunosorbent assay.
Higher levels of urine survivin were associated with an increased risk of bladder cancer (p <0.001) and tumors of higher grade (p = 0.037), but not with invasive stage, after adjustment for the effects of urine cytology, NMP22 and age. The sensitivity, specificity, and positive and negative predictive values of survivin for the diagnosis of bladder cancer (64%, 93%, 92% and 67%, respectively), are superior to those of NMP22 and cytology. Survivin had the highest specificity and positive predictive value for the detection of bladder cancer across each tumor stage and grade.
Urine survivin was a strong, independent predictor of the presence of bladder cancer and higher tumor grade. Urine detection of survivin is an accurate diagnostic test for bladder cancer that retains its efficiency regardless of cancer stage and grade.
在一项初步研究中，对细胞凋亡和有丝分裂的整合因子生存素进行尿液检测，可准确检测出膀胱癌。本研究的目的是在一大群接受膀胱镜检查的受试者中证实这些发现，评估尿液生存素的诊断性能，并测试尿液生存素评估对于尿液核基质蛋白22（Matritech公司，马萨诸塞州剑桥）和细胞学检查在膀胱癌检测方面是否具有独立价值。
使用Bio-Dot微滤检测系统（Bio-Rad公司，加利福尼亚州赫拉克勒斯）对117例病例和92例对照在膀胱镜检查前收集的晨尿标本中的尿液生存素进行检测。在174名受试者中收集用于细胞学检查的膀胱冲洗样本。使用市售的酶联免疫吸附测定法测量尿液中NMP22的水平。
在调整尿液细胞学、NMP22和年龄的影响后，尿液生存素水平升高与膀胱癌风险增加（p<0.001）和高级别肿瘤（p = 0.037）相关，但与浸润期无关。生存素诊断膀胱癌的敏感性、特异性、阳性和阴性预测值（分别为64%、93%、92%和67%）优于NMP22和细胞学检查。在每个肿瘤分期和分级中，生存素对膀胱癌检测的特异性和阳性预测值最高。
尿液生存素是膀胱癌存在和更高肿瘤分级的强有力的独立预测指标。尿液生存素检测是一种准确的膀胱癌诊断试验，无论癌症分期和分级如何，均保持其有效性。
