Miremami Jahan, Kyprianou Natasha
Departments of Urology and Molecular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
Int J Mol Sci. 2014 Dec 22;15(12):23897-908. doi: 10.3390/ijms151223897.
Bladder cancer is the fourth most common malignancy in the US and is associated with the highest cost per patient. A high likelihood of recurrence, mandating stringent surveillance protocols, has made the development of urinary markers a focus of intense pursuit with the hope of decreasing the burden this disease places on patients and the healthcare system. To date, routine use of markers is not recommended for screening or diagnosis. Interests include the development of a single urinary marker that can be used in place of or as an adjunct to current screening and surveillance techniques, as well identifying a molecular signature for an individual's disease that can help predict progression, prognosis, and potential therapeutic response. Markers have shown potential value in improving diagnostic accuracy when used as an adjunct to current modalities, risk-stratification of patients that could aid the clinician in determining aggressiveness of surveillance, and allowing for a decrease in invasive surveillance procedures. This review discusses the current understanding of emerging biomarkers, including miRNAs, gene signatures and detection of circulating tumor cells in the blood, and their potential clinical value in bladder cancer diagnosis, as prognostic indicators, and surveillance tools, as well as limitations to their incorporation into medical practice.
膀胱癌是美国第四大常见恶性肿瘤，且每位患者的治疗成本最高。由于复发可能性高，需要严格的监测方案，因此开发尿液标志物成为人们密切关注的焦点，希望以此减轻这种疾病给患者和医疗系统带来的负担。迄今为止，不建议将标志物常规用于筛查或诊断。研究兴趣包括开发一种单一的尿液标志物，可用于替代当前的筛查和监测技术或作为其辅助手段，以及识别个体疾病的分子特征，以帮助预测疾病进展、预后和潜在的治疗反应。当作为当前检测方法的辅助手段使用时，标志物在提高诊断准确性、对患者进行风险分层（这有助于临床医生确定监测的积极程度）以及减少侵入性监测程序方面已显示出潜在价值。本综述讨论了对新兴生物标志物的当前认识，包括微小RNA、基因特征以及血液中循环肿瘤细胞的检测，及其在膀胱癌诊断中作为预后指标和监测工具的潜在临床价值，以及将它们纳入医疗实践的局限性。
