Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler -Str. 3, 72076, Tuebingen, Germany.
World J Urol. 2010 Jun;28(3):399-404. doi: 10.1007/s00345-010-0538-2. Epub 2010 Mar 23.
This study was carried out as a prospective pilot study to evaluate the potential of survivin mRNA measurement in patients suspicious for urothelial bladder cancer (BC). Data were also analyzed for possible influences of secondary urological findings on survivin measurements.
Survivin was measured by an mRNA assay in voided urine samples of 50 patients with suspicion of new or recurrent BC prior to transurethral resection. Sample evaluation was possible in 49 cases. Histopathology revealed no malignancy in 17 (35%) and BC in 32 (65%) patients. Survivin mRNA was quantitated by real-time PCR from frozen cell pellets of centrifuged urine samples. A ROC analysis of the survivin data was performed.
ROC analysis identified the best cut-off level at 10,000 mRNA copies, resulting in a sensitivity of 53% and a specificity of 88%. Seven of the 20 pTa tumors (35%), all four pT1 (100%) and all four muscle-invasive tumors (100%) were detected. Of four patients with carcinoma in situ (Cis), 50% could be identified. Only two patients (4%) were assessed as false positive. Histologically confirmed cystitis and concomitant urological findings (inflammatory cells in urine, microhematuria and others) had no detectable influence on survivin measurements.
In present group of patients, survivin was a reliable biomarker for high-grade urothelial BC (sensitivity 83%), but not for low grade (sensitivity 35%) urothelial BC with a high specificity (88%). No confounders influencing the results of survivin measurements could be identified.
本研究为前瞻性初步研究，旨在评估在疑似膀胱癌（BC）患者中检测生存素 mRNA 的潜在价值。同时分析次要泌尿系统发现对生存素检测的可能影响。
对 50 例疑似新发或复发 BC 行经尿道切除术的患者进行前瞻性初步研究。对 49 例患者的尿液样本进行了生存素 mRNA 检测。对冷冻的离心尿液细胞沉淀进行实时 PCR 定量分析。对生存素数据进行 ROC 分析。
ROC 分析确定最佳截断值为 10000 个 mRNA 拷贝，敏感性为 53%，特异性为 88%。20 例 Ta 肿瘤中有 7 例（35%）、4 例 T1（100%）和 4 例肌层浸润性肿瘤（100%）被检测到。4 例原位癌（Cis）中有 50%可被识别。仅有 2 例（4%）被误报为阳性。组织学证实的膀胱炎和同时存在的泌尿系统发现（尿液中炎症细胞、镜下血尿等）对生存素检测结果没有可检测的影响。
在本研究的患者中，生存素是高级别尿路上皮 BC 的可靠生物标志物（敏感性 83%），但对低级别（敏感性 35%）尿路上皮 BC 不敏感（敏感性 88%）。未发现影响生存素检测结果的混杂因素。
