FGFR3, TERT and OTX1 as a Urinary Biomarker Combination for Surveillance of Patients with Bladder Cancer in a Large Prospective Multicenter Study

W Beukers, KA van der Keur, R Kandimalla… - The Journal of …, 2017 - auajournals.org
W Beukers, KA van der Keur, R Kandimalla, Y Vergouwe, EW Steyerberg, JL Boormans
The Journal of urology, 2017auajournals.org
Purpose: Patients with nonmuscle invasive bladder cancer are followed with frequent
cystoscopies. In this study FGFR3, TERT and OTX1 were investigated as a diagnostic
urinary marker combination during followup of patients with primary nonmuscle invasive
bladder cancer. Materials and Methods: In this international, multicenter, prospective study
977 patients with nonmuscle invasive bladder cancer were included. A total of 2,496 urine
samples were collected prior to cystoscopy during regular visits. Sensitivity was estimated to …
Purpose
Patients with nonmuscle invasive bladder cancer are followed with frequent cystoscopies. In this study FGFR3, TERT and OTX1 were investigated as a diagnostic urinary marker combination during followup of patients with primary nonmuscle invasive bladder cancer.
Materials and Methods
In this international, multicenter, prospective study 977 patients with nonmuscle invasive bladder cancer were included. A total of 2,496 urine samples were collected prior to cystoscopy during regular visits. Sensitivity was estimated to detect concomitant recurrences. Kaplan-Meier curves were used to estimate the development of future recurrences after urinalysis and a negative cystoscopy.
Results
Sensitivity of the assay combination for recurrence detection was 57% in patients with primary low grade, nonmuscle invasive bladder cancer. However, sensitivity was 83% for recurrences that were pT1 or muscle invasive bladder cancer. Of the cases 2% progressed to muscle invasive bladder cancer. Sensitivity for recurrence detection in patients with primary high grade disease was 72% and 7% of them had progression to muscle invasive bladder cancer. When no concomitant tumor was found by cystoscopy, positive urine samples were more frequently followed by a recurrence over time compared to a negative urine sample (58% vs 36%, p <0.001). High stage recurrences were identified within 1 year after a positive urine test and a negative cystoscopy.
Conclusions
Recurrences in patients with primary nonmuscle invasive bladder cancer can be detected by a combination of urine assays. This study supports the value of urinalysis as an alternative diagnostic tool in patients presenting with low grade tumors and as a means to identify high stage tumors earlier.
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