Stepwise Application of Urine Markers to Detect Tumor Recurrence in Patients Undergoing Surveillance for Non-Muscle-Invasive Bladder CancerReportar como inadecuado

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Disease Markers - Volume 2014 2014, Article ID 973406, 7 pages -

Research Article

Department of Urology, Eberhard-Karls University, Hoppe-Seyler Strasse 3, 72076 Tübingen, Germany

Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, BC, Canada V6H 3Z6

Received 11 September 2014; Accepted 5 December 2014; Published 22 December 2014

Academic Editor: Marco E. M. Peluso

Copyright © 2014 Tilman Todenhöfer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The optimal use of urine markers in the surveillance of non-muscle-invasive bladder cancer NMIBC remains unclear. Aim of the present study was to investigate the combined and stepwise use of the four most broadly available urine markers to detect tumor recurrence in patients undergoing surveillance of NMIBC. Patients and Methods. 483 patients with history of NMIBC were included. Cytology, UroVysion, fluorescence in situ hybridization FISH, immunocytology uCyt+, and NMP22 ELISA were performed before surveillance cystoscopy. Characteristics of single tests and combinations were assessed by contingency analysis. Results. 128 26.5% patients had evidence of tumor recurrence. Sensitivities and negative predictive values NPVs of the single tests ranged between 66.4–74.3 and 82.3–88.2%. Two-marker combinations showed sensitivities and NPVs of 80.5–89.8 and 89.5–91.2%. A stepwise application of the two-test combinations with highest accuracy cytology and FISH; cytology and uCyt+; uCyt+ and FISH showed NPVs for high-risk recurrences G3-Cis-pT1 of 98.8, 98.8, and 99.1%, respectively. Conclusions. Combinations of cytology, FISH, immunocytology, and NMP22 show remarkable detection rates for recurrent NMIBC. Stepwise two-test combinations of cytology, FISH, and immunocytology have a low probability of missing a high-risk tumor. The high sensitivities may justify the use of these combinations in prospective studies assessing the use of urine markers to individualize intervals between cystoscopies during follow-up.

Autor: Tilman Todenhöfer, Jörg Hennenlotter, Michael Esser, Sarah Mohrhardt, Stefan Aufderklamm, Johannes Böttge, Steffen Rausch



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