Białek Łukasz, Niemczyk Michał, Czerwińska Katarzyna, Nowak Mateusz, Sadowska Anna, Borkowski Tomasz, Radziszewski Piotr, Dobruch Jakub, Kryst Piotr, Poletajew Sławomir
I Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland.
Cent European J Urol. 2021;74(3):295-299. doi: 10.5173/ceju.2021.0080.2.R1. Epub 2021 Jul 7.
Urine concentration of human kidney injury molecule-1 (KIM-1) is suggested to be increased in patients with renal cell carcinoma (RCC). However, it has never been tested in patients with urothelial tumors, while preoperative differentiation between RCC and upper tract urothelial carcinoma (UTUC) plays an essential role in therapeutic decisions.The aim of the study was to evaluate the role of urinary KIM-1 expression in preoperative differentiation between RCC and urothelial carcinoma (UC).
Sixty-four participants were enrolled in the study, including 30 patients with RCC and 27 with UC (16 with UTUC and 11 with bladder tumor). Preoperative urinary KIM-1 levels were measured using a commercially available ELISA kit and normalized to urinary creatinine levels.
The median concentration of urinary KIM-1 normalized to urinary creatinine was lower in patients with RCC compared to UC (1.35 vs 1.86 ng/mg creatinine, p = 0.04). The comparison between RCC and UTUC shows even more significant difference (1.33 vs 2.23 ng/mg creatinine, p = 0.02). Urinary KIM-1 concentration did not correlate with tumor stage nor grade in any of the groups. ROC analysis to identify UC revealed AUC of 0.657 with sensitivity 33.3% and specificity 96.7% at the cut-off value of 3.226 ng/mg creatinine. Among patients with eGFR ≥60 mL/min/1.73 m², ROC analysis to detect UC achieved AUC of 0.727 with sensitivity 69.5% and specificity 70.2%.
Urine KIM-1 can potentially differentiate UC from RCC. However, a wide range of observed results and limited sensitivity and specificity requires caution in making clinical decisions before confirmatory studies.
肾细胞癌（RCC）患者的人肾损伤分子-1（KIM-1）尿浓度被认为会升高。然而，其在尿路上皮肿瘤患者中从未得到检测，而RCC与上尿路尿路上皮癌（UTUC）的术前鉴别在治疗决策中起着至关重要的作用。本研究的目的是评估尿KIM-1表达在RCC与尿路上皮癌（UC）术前鉴别中的作用。
64名参与者纳入本研究，包括30例RCC患者和27例UC患者（16例UTUC患者和11例膀胱肿瘤患者）。使用市售ELISA试剂盒测量术前尿KIM-1水平，并根据尿肌酐水平进行标准化。
与UC患者相比，RCC患者经尿肌酐标准化后的尿KIM-1中位浓度较低（1.35对1.86 ng/mg肌酐，p = 0.04）。RCC与UTUC之间的比较显示出更显著的差异（1.33对2.23 ng/mg肌酐，p = 0.02）。在任何一组中，尿KIM-1浓度均与肿瘤分期和分级无关。用于识别UC的ROC分析显示，在肌酐水平为3.226 ng/mg的临界值时，AUC为0.657，敏感性为33.3%，特异性为96.7%。 在估算肾小球滤过率（eGFR）≥60 mL/min/1.73 m²的患者中，检测UC的ROC分析的AUC为0.727，敏感性为69.5%，特异性为70.2%。
尿KIM-1有可能区分UC与RCC。然而，观察结果范围广泛且敏感性和特异性有限，在进行确证性研究之前，临床决策时需谨慎。
