Lozano Fernando, Raventós Carles X, Carrion Albert, Dinarés Carme, Hernández Javier, Trilla Enrique, Morote Juan
Department of Urology, Vall d'Hebron University Hospital, Universitat Autonoma Barcelona, 08035 Barcelona, Spain.
Pathology Department, Vall d'Hebron University Hospital, 08035 Barcelona, Spain.
Cancers (Basel). 2023 Jul 19;15(14):3683. doi: 10.3390/cancers15143683.
XBM was prospectively assessed in spontaneous urine collected just before flexible cystoscopy and washing cytology carried out within the first 2 years follow-up of 337 patients with NMIBC. Recurrences were pathologically confirmed in 49 patients (14.5%), 22 of them being high-risk (6.5%). The XBM sensitivity for detecting any type of recurrence was 69.4% and 63.6% in the cases of high-risk NMIBC. Negative predictive value (NPV) for XBM was 93% for all recurrences and 96.2% for high-risk recurrences. XBM could have avoided 213 invasive controls but missed the detection of 15 recurrences (30.6%)-8 of them of high-risk (36.4%). XBM false positive elevations were detected in 90 patients (26.7%), whereas 10 patients with the invasive method had a false positive result (3%), <0.001. However, early detection of recurrences during the first year's follow-up after an XBM false positive result was observed in 18 patients (20%). On the other hand, 19 recurrences were detected during this period among the rest of the patients (7.7%)- = 0.003, and odds ratio (OR) 3.0 (95% CI 1.5-6.0). Regarding one-year follow-up recurrences, 10% were high-risk recurrences in the XBM false positive group and 3.2% in the rest of the patients- = 0.021, and OR 3.3 (95% CI 1.2-8.9). Additionally, 11.3% of the patients without false positive results developed a recurrence, = 0.897, for any recurrence, being 10% and 5.2%, respectively, and high-risk and low-risk recurrences, = 0.506. After searching for the best XBM cutoff for detecting the 38 high-risk initial recurrences and the early high-risk recurrences after a one-year follow-up, a linear discriminant analysis (LDA) of 0.13 could have avoided 11.3% of cystoscopies and bladder wash cytologies, as this cutoff missed only 1 high-risk recurrence (2.6%). More extensive and well-designed studies will confirm if XBM can improve the surveillance of NMIBC.
在337例非肌层浸润性膀胱癌（NMIBC）患者的前2年随访期间，在进行软性膀胱镜检查前即刻收集的自发尿液中对XBM进行前瞻性评估，并进行冲洗细胞学检查。49例患者（14.5%）经病理证实复发，其中22例为高危复发（6.5%）。XBM检测任何类型复发的敏感性在高危NMIBC病例中为69.4%，在高危复发病例中为63.6%。XBM的阴性预测值（NPV）对于所有复发为93%，对于高危复发为96.2%。XBM可避免213次侵入性检查，但漏诊了15例复发（30.6%），其中8例为高危复发（36.4%）。90例患者（26.7%）检测到XBM假阳性升高，而10例采用侵入性方法的患者出现假阳性结果（3%），P<0.001。然而，在观察到XBM假阳性结果后的第一年随访期间，18例患者（20%）早期检测到复发。另一方面，在此期间其余患者中检测到19例复发（7.7%），P = 0.003，优势比（OR）为3.0（95%CI 1.5 - 6.0）。关于一年随访复发情况，XBM假阳性组中10%为高危复发，其余患者中为3.2%，P = 0.021，OR为3.3（95%CI 1.2 - 8.9）。此外，无假阳性结果的患者中有11.3%出现复发，对于任何复发，P = 0.897，高危复发和低危复发分别为10%和5.2%，P = 0.506。在寻找用于检测38例高危初始复发和一年随访后的早期高危复发的最佳XBM临界值后，线性判别分析（LDA）得出的0.13临界值可避免11.3%的膀胱镜检查和膀胱冲洗细胞学检查，因为该临界值仅漏诊1例高危复发（2.6%）。更广泛且设计良好的研究将证实XBM是否能改善NMIBC的监测。
