Landman J, Chang Y, Kavaler E, Droller M J, Liu B C
Department of Urology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Urology. 1998 Sep;52(3):398-402. doi: 10.1016/s0090-4295(98)00219-2.
The recent introduction of novel molecular markers into clinical urology has created a need to evaluate the efficacy and utility of these potential markers. The ideal assay for bladder cancer should be noninvasive, sensitive, specific, and cost-effective. We compared the Matritech nuclear maxtrix protein (NMP)-22 assay, telomerase activity, and the Bard bladder tumor antigen (BTA) assay for the detection of human bladder cancer.
A single voided urine sample was obtained from patients with hematuria without bladder cancer and from patients with known bladder cancer before any treatment. Approximately 50 to 100 mL of voided urine sample was collected and aliquotted for the various assays. The results were compared to single cytologic results and ultimately to pathologic findings.
In 47 patients with bladder cancer, the overall sensitivity was 81% for NMP-22, 80% for telomerase, 40% for BTA, and 40% for cytology. For Ta tumors (n = 31), sensitivity was 81% for NMP-22, 70% for telomerase, 32% for BTA, and 26% for cytology. For T1 or higher stage tumors (n = 13), sensitivity was 82% for NMP-22, 91% for telomerase, 64% for BTA, and 64% for cytology. The remaining 3 patients had carcinoma in situ (CIS). When tumors were stratified by tumor grade, grade I tumors (n = 16) were detected at 69% with NMP-22, 65% with telomerase, 13% with BTA, and 6% with cytology. Grade II tumors (n = 14) were detected at 86% with NMP-22, 72% with telomerase, 36% with BTA, and 36% with cytology. Grade III tumors (n = 14) were detected at 93% with NMP-22, 93% with telomerase, 79% with BTA, and 79% with cytology. Patients with CIS (n = 3) were detected at 67% with NMP-22, 100% with telomerase, 33% with BTA, and 67% with cytology. In 30 patients with hematuria but without bladder cancer, the overall specificity of the assays was 77% for NMP-22, 80% for telomerase, 73% for BTA, and 94% for cytology.
In the population tested, NMP-22 and the telomerase assays gave similar sensitivity and specificity for the detection of bladder cancer, and appear to offer a greater sensitivity than the BTA assay and/or conventional cytology.
近期新型分子标志物引入临床泌尿外科，因此有必要评估这些潜在标志物的有效性和实用性。理想的膀胱癌检测方法应是非侵入性的、敏感的、特异的且具有成本效益。我们比较了Matritech核基质蛋白（NMP）-22检测、端粒酶活性检测以及Bard膀胱肿瘤抗原（BTA）检测在检测人类膀胱癌方面的效果。
从无膀胱癌的血尿患者以及未接受任何治疗的已知膀胱癌患者中获取单次晨尿样本。收集约50至100毫升晨尿样本并分装用于各种检测。将结果与单次细胞学检查结果进行比较，并最终与病理检查结果进行比较。
在47例膀胱癌患者中，NMP-22的总体敏感性为81%，端粒酶为80%，BTA为40%，细胞学检查为40%。对于Ta期肿瘤（n = 31），NMP-22的敏感性为81%，端粒酶为70%，BTA为32%，细胞学检查为26%。对于T1期或更高分期的肿瘤（n = 13），NMP-22的敏感性为82%，端粒酶为91%，BTA为64%，细胞学检查为64%。其余3例患者为原位癌（CIS）。当按肿瘤分级对肿瘤进行分层时，I级肿瘤（n = 16）通过NMP-22检测的比例为69%，端粒酶为65%，BTA为13%，细胞学检查为6%。II级肿瘤（n = 14）通过NMP-22检测的比例为86%，端粒酶为72%，BTA为36%，细胞学检查为36%。III级肿瘤（n = 14）通过NMP-22检测的比例为93%，端粒酶为93%，BTA为79%，细胞学检查为79%。CIS患者（n = 3）通过NMP-22检测的比例为67%，端粒酶为100%，BTA为33%，细胞学检查为67%。在30例有血尿但无膀胱癌的患者中，这些检测方法的总体特异性分别为：NMP-22为77%，端粒酶为80%，BTA为73%，细胞学检查为94%。
在所检测的人群中，NMP-22检测和端粒酶检测在检测膀胱癌方面具有相似的敏感性和特异性，并且似乎比BTA检测和/或传统细胞学检查具有更高的敏感性。
