The Predictive Value of Urinary Twist1 Methylation and VI-RADS Score for Residual Tumor before Repeat Transurethral Resection of Bladder Tumor in NMIBC Patients.

INTRODUCTION

Although cystoscopy is highly accurate in managing bladder cancer, its invasive nature and high cost underscore the need for more practical, noninvasive alternatives. Urinary Twist Family BHLH Transcription Factor 1 (Twist1) methylation, an emerging biomarker, shows great promise for early diagnosis and postsurgical monitoring. Meanwhile, the Vesical Imaging-Reporting and Data System (VI-RADS), which incorporates multiple sequences of multiparametric MRI, demonstrates excellent diagnostic performance for bladder cancer. These tools could potentially overcome the limitations in managing non-muscle invasive bladder cancer (NMIBC), particularly in predicting residual tumor burden before repeat transurethral resection of bladder tumor (re-TURBT). This study aims to evaluate a predictive model that combines VI-RADS, urinary Twist1 methylation, and hematuria to guide clinical decision-making in NMIBC management.

METHODS

A prospective cohort study was conducted, including NMIBC patients who underwent re-TURBT at the Department of Urology, Zhongshan city People's Hospital, from June 2022 to May 2024. Morning urine samples were collected prior to re-TURBT to detect urinary Twist1 methylation, and a 3.0T MRI scan of the bladder was performed for VI-RADS scoring. Based on postoperative pathology results, patients were divided into residual tumor and non-residual tumor groups. Binary logistic regression was employed to identify independent predictors of residual tumor burden prior to re-TURBT. Two predictive models were subsequently developed. The diagnostic performance and clinical utility of these models were assessed using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

RESULTS

The study ultimately included 52 patients who were initially diagnosed with NMIBC based on pathology. According to the pathological results after re-TURBT, the patients were divided into two groups: the tumor residue group (n = 22) and the control group (n = 30). Binary logistic regression analysis identified the VI-RADS score and urinary Twist1 methylation as independent predictors of residual tumor burden in NMIBC patients prior to re-TURBT. A predictive model incorporating these factors, along with the presence of visible hematuria within 1 week before re-TURBT, achieved a sensitivity of 95.45% and a specificity of 83.33% for diagnosing residual tumor burden. ROC curve analysis demonstrated an area under the curve (AUC) of 0.950 (95% CI: 0.884-1.000, p < 0.001). DCA revealed that the model provided a net benefit for threshold probabilities ranging from 0.10 to 0.92.

CONCLUSION

The predictive model combining VI-RADS score, urinary Twist1 methylation, and visible hematuria exhibits excellent diagnostic performance for predicting residual tumor burden in NMIBC patients, offering significant guidance for clinical practice.