用于膀胱癌检测和监测的生物标志物。
Biomarkers for detection and surveillance of bladder cancer.
作者信息
Budman Lorne I, Kassouf Wassim, Steinberg Jordan R
机构信息
Division of Urology, McGill University Health Centre, Montréal, Que.
出版信息
Can Urol Assoc J. 2008 Jun;2(3):212-21. doi: 10.5489/cuaj.600.
INTRODUCTION
Bladder cancer is the fourth most common cancer in men and the ninth most common cancer in women in Canada. Early detection of tumours is essential for improved prognosis and long-term survival. The standard method for detection and surveillance is cystoscopy together with urine cytology. Cystoscopy is relatively sensitive but is expensive and invasive. Urinary cytology is a noninvasive method that has poor sensitivity but high specificity; it is relied on for the detection of carcinoma in situ. Currently, several urinary-based bladder tumour biomarkers with USFDA/Health Canada approval are available commercially, but none have been widely adopted by urologists despite their offering high sensitivity and/or specificity. We present here a review of recent studies evaluating 7 commercial biomarker assays for the detection and/or surveillance of bladder cancer.
RESULTS
SENSITIVITY AND SPECIFICITY RANGES, RESPECTIVELY, FOR EACH MARKER WERE REPORTED AS FOLLOWS: BTA Stat (Polymedco), 52.5%-78.0% and 69.0%-87.1%; BTA Trak (Polymedco), 51%-100% and 73%-92.5%; cytology, 12.1%-84.6% and 78.0%-100%; hematuria dipstick, 47.0%-92.6% and 51.0%-84.0%; NMP22 Bladder Cancer Test (Matritech), 34.6%-100% and 60.0%-95.0%; NMP22 BladderChek (Matritech), 49.5%-65.0% and 40.0%-89.8%; ImmunoCyt/uCyt+ (DiagnoCure), 63.3%-84.9% and 62.0%-78.1%; ImmunoCyt/uCyt+ and cytology, 81.0%-89.3% and 61.0%-77.7%; and UroVysion (Abbott Molecular)/florescence in situ hybridization, 68.6%-100% and 65.0%-96.0%.
CONCLUSION
We find that no currently available bladder cancer urinary marker is sensitive enough to eliminate the need for cystoscopy. In addition, cytology remains integral to the detection of occult cancer. However, owing to their relatively high sensitivities, these markers may be used to extend the period between cystoscopies in the surveillance of patients with transitional cell carcinoma. Further study is required to determine which markers, alone or in panel, would best accomplish this.
引言
在加拿大，膀胱癌是男性中第四大常见癌症，女性中第九大常见癌症。早期发现肿瘤对于改善预后和长期生存至关重要。检测和监测的标准方法是膀胱镜检查及尿液细胞学检查。膀胱镜检查相对敏感，但费用高且具有侵入性。尿液细胞学检查是一种非侵入性方法，敏感性差但特异性高；它依赖于原位癌的检测。目前，有几种经美国食品药品监督管理局/加拿大卫生部批准的基于尿液的膀胱肿瘤生物标志物已在市场上销售，但尽管它们具有高敏感性和/或特异性，却未被泌尿科医生广泛采用。我们在此对近期评估7种用于检测和/或监测膀胱癌的商业生物标志物检测方法的研究进行综述。
结果
各标志物的敏感性和特异性范围分别报告如下：BTA Stat（Polymedco公司），52.5% - 78.0%和69.0% - 87.1%；BTA Trak（Polymedco公司），51% - 100%和73% - 92.5%；细胞学检查，12.1% - 84.6%和78.0% - 100%；血尿试纸条，47.0% - 92.6%和51.0% - 84.0%；NMP22膀胱癌检测（Matritech公司），34.6% - 100%和60.0% - 95.0%；NMP22膀胱检测（Matritech公司），49.5% - 65.0%和40.0% - 89.8%；免疫细胞/uCyt +（DiagnoCure公司），63.3% - 84.9%和62.0% - 78.1%；免疫细胞/uCyt +与细胞学检查，81.0% - 89.3%和61.0% - 77.7%；以及UroVysion（雅培分子公司）/荧光原位杂交，68.6% - 100%和65.0% - 96.0%。
结论
我们发现，目前可用的膀胱癌尿液标志物没有一种敏感到足以消除对膀胱镜检查的需求。此外，细胞学检查对于隐匿性癌症的检测仍然不可或缺。然而，由于这些标志物具有相对较高的敏感性，它们可用于延长对移行细胞癌患者进行监测时膀胱镜检查之间的间隔时间。需要进一步研究以确定哪些标志物单独使用或联合使用能最好地实现这一点。
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