Xpert Bladder Cancer Monitor for the Early Detection of Non-Muscle Invasive Bladder Cancer Recurrences : Could Cystoscopy Be Substituted?
Lozano, Fernando (Hospital Universitari Vall d'Hebron)
Raventós, Carles X. (Hospital Universitari Vall d'Hebron)
Carrion, Albert (Hospital Universitari Vall d'Hebron)
Dinarès Fernández, Carme (Hospital Universitari Vall d'Hebron)
Hernandez-Losa, Javier (Hospital Universitari Vall d'Hebron)
Trilla Herrera, Enrique (Hospital Universitari Vall d'Hebron)
Morote Robles, Juan (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Non-muscle invasive bladder cancer (NMIBC) accounts for three quarters of newly detected bladder tumors. NMIBC can be treated conservatively with a bladder transurethral resection (bTUR), although recurrences are common despite adjuvant treatments. High-risk recurrent NMIBC can progress to muscle invasive bladder cancer (MIBC) and decrease survival. Therefore, close invasive surveillance, based on cystoscopy and washing cytology, is currently recommended, especially in high-risk recurrent tumors. Urine biomarkers have been investigated unsuccessfully to avoid or postpone the invasive surveillance of NMIBC. Xpert Bladder Cancer Monitor ® (XBM) is a new genetic urine biomarker that assesses the expression of five miRNA profiles. In the present study, XBM was not sensitive enough to detect all high-risk recurrences and avoid cystoscopy and washing cytology. However, false positive XBM results can predict early high-risk recurrences. 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%), p <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%)- p = 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- p = 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, p = 0. 897, for any recurrence, being 10% and 5. 2%, respectively, and high-risk and low-risk recurrences, p = 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.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Bladder cancer ; Biomarker ; Surveillance
Publicat a:	Cancers, Vol. 15 (july 2023) , ISSN 2072-6694

DOI: 10.3390/cancers15143683
PMID: 37509344

16 p, 988.7 KB

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