Schmitz-Dräger Bernd J, Droller Michael, Lokeshwar Vinata B, Lotan Yair, Hudson M'Liss A, van Rhijn Bas W, Marberger Michael J, Fradet Yves, Hemstreet George P, Malmstrom Per-Uno, Ogawa Osamu, Karakiewicz Pierre I, Shariat Shahrokh F
Urologie24/Urologie, Schön Klinik Nürnberg Fürth, Fürth, Germany.
Urol Int. 2015;94(1):1-24. doi: 10.1159/000369357. Epub 2014 Dec 10.
Due to the lack of disease-specific symptoms, diagnosis and follow-up of bladder cancer has remained a challenge to the urologic community. Cystoscopy, commonly accepted as a gold standard for the detection of bladder cancer, is invasive and relatively expensive, while urine cytology is of limited value specifically in low-grade disease. Over the last decades, numerous molecular assays for the diagnosis of urothelial cancer have been developed and investigated with regard to their clinical use. However, although all of these assays have been shown to have superior sensitivity as compared to urine cytology, none of them has been included in clinical guidelines. The key reason for this situation is that none of the assays has been included into clinical decision-making so far. We reviewed the current status and performance of modern molecular urine tests following systematic analysis of the value and limitations of commercially available assays. Despite considerable advances in recent years, the authors feel that at this stage the added value of molecular markers for the diagnosis of urothelial tumors has not yet been identified. Current data suggest that some of these markers may have the potential to play a role in screening and surveillance of bladder cancer. Well-designed protocols and prospective, controlled trials will be needed to provide the basis to determine whether integration of molecular markers into clinical decision-making will be of value in the future.
由于缺乏疾病特异性症状，膀胱癌的诊断和随访一直是泌尿外科领域面临的挑战。膀胱镜检查是公认的检测膀胱癌的金标准，但具有侵入性且相对昂贵，而尿细胞学检查在低级别疾病中价值有限。在过去几十年中，已经开发并研究了许多用于诊断尿路上皮癌的分子检测方法及其临床应用。然而，尽管所有这些检测方法都显示出比尿细胞学检查具有更高的灵敏度，但它们都未被纳入临床指南。出现这种情况的关键原因是迄今为止，没有一种检测方法被纳入临床决策。在系统分析市售检测方法的价值和局限性后，我们回顾了现代分子尿液检测的现状和性能。尽管近年来取得了相当大的进展，但作者认为在现阶段，用于诊断尿路上皮肿瘤的分子标志物的附加价值尚未得到确认。目前的数据表明，其中一些标志物可能在膀胱癌的筛查和监测中发挥作用。需要精心设计的方案和前瞻性对照试验，为确定分子标志物是否会在未来的临床决策中具有价值提供依据。
