Duquesne Igor, Weisbach Lars, Aziz Atiqullah, Kluth Luis A, Xylinas Evanguelos
Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Transl Androl Urol. 2017 Dec;6(6):1031-1042. doi: 10.21037/tau.2017.11.29.
Despite advances in the surgical and medical treatment of bladder cancer, there have only been minor improvements in mortality and morbidity rates over the past decades. Urine-based markers help to improve diagnosing bladder cancer with the aim of complementing or probably in future replacing cystoscopy. Biomarkers may allow individualized risk stratification and support decision-making regarding therapy and follow-up. This review summarizes the existing urine-based biomarkers in bladder cancer. We conducted a comprehensive review of the literature. We conducted a PubMed/Medline based research on English language articles and selected original articles and review articles that provided both description and assessment of urinary markers at time of screening, initial diagnosis, monitoring and prognostic evaluation of urothelial bladder cancer. Our research covered studies published between 2000 and 2017. The aim of this study was to give clinicians keys to understand the existing or promising urinary markers that may become alternatives to cytology/cystoscopy pair in the near future. Many urinary markers are now available, often with superior sensitivity to cytology. Their uses have been evaluated in numerous clinical situations in addition to the time of initial diagnosis and surveillance such as cases of isolated macroscopic hematuria or atypical cytology discordant with the rest of the explorations. However, their superiority over the cytology/cystoscopy association is not demonstrated. These new markers are lacking for the most part of standardization and simplicity making their use in common practice difficult. the types and forms of these new markers are very heterogeneous among themselves and between the studies that evaluate them. Well-designed protocols and prospective, controlled trials are needed to provide the basis to determine whether integration of urine- and blood-based biomarkers into clinical decision-making will be of value for bladder cancer detection and screening in the future.
尽管膀胱癌的手术和药物治疗取得了进展，但在过去几十年中，死亡率和发病率仅略有改善。基于尿液的标志物有助于改善膀胱癌的诊断，目的是补充或可能在未来取代膀胱镜检查。生物标志物可以实现个体化风险分层，并为治疗和随访决策提供支持。本综述总结了现有的基于尿液的膀胱癌生物标志物。我们对文献进行了全面综述。我们在PubMed/Medline上对英文文章进行了检索，选择了在尿路上皮膀胱癌筛查、初始诊断、监测和预后评估时提供尿液标志物描述和评估的原创文章和综述文章。我们的研究涵盖了2000年至2017年发表的研究。本研究的目的是为临床医生提供关键信息，以了解现有或有前景的尿液标志物，这些标志物可能在不久的将来成为细胞学/膀胱镜检查组合的替代方法。现在有许多尿液标志物可供使用，其敏感性通常优于细胞学检查。除了初始诊断和监测时，它们在许多临床情况下的应用也得到了评估，例如孤立性肉眼血尿或与其他检查结果不一致的非典型细胞学病例。然而，它们相对于细胞学/膀胱镜检查组合的优越性尚未得到证实。这些新标志物在很大程度上缺乏标准化和简单性，使得它们在临床实践中的应用困难。这些新标志物的类型和形式在它们自身之间以及评估它们的研究之间非常异质。需要精心设计的方案和前瞻性对照试验，以为确定将基于尿液和血液的生物标志物整合到临床决策中是否对未来膀胱癌的检测和筛查有价值提供依据。
