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Vol. 43. Issue 8.
Pages 404-413 (October 2019)
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Vol. 43. Issue 8.
Pages 404-413 (October 2019)
Review article
DOI: 10.1016/j.acuroe.2019.03.014
Urinary markers in the surveillance of non-muscle invasive bladder cancer. A literature review
Marcadores urinarios en la vigilancia del tumor vesical no músculo infiltrante. Revisión de la literatura
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F. Agreda Castañedaa,
Corresponding author
fagreda.germanstrias@gencat.cat

Corresponding author.
, C.X. Raventós Busquetsb,c, J. Morote Roblesb,c
a Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
b Hospital Universitario Vall d’Hebron, Barcelona, Spain
c Universitat Autónoma de Barcelona, Barcelona, Spain
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Figures (2)
Tables (5)
Table 1. Summary of studies with RNA. Patients and measures of diagnostic accuracy are shown.
Table 2. Summary of studies with DNA. Patients and measures of diagnostic accuracy are shown.
Table 3. Summary of studies with protein markers. Patients and measures of diagnostic accuracy are shown.
Table 4. Summary of studies with cellular assays. Patients and measures of diagnostic accuracy are shown.
Table 5. Summary of studies that report markers for early detection. Maximum follow-up time, “false positive” rates and recurrence percentages are shown.
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Abstract
Background

The surveillance of non-muscle-invasive bladder cancer (NMIBC) is usually performed by cystoscopy and cytology. Until today, no effective urinary biomarker has been used to reduce the morbidity and cost associated with these procedures.

Objective

To describe the performance of urinary biomarkers in the surveillance of NMIBC.

Evidence acquisition

On August 1, 2018, a bibliographic search was carried out in Pubmed, Embase and Cochrane Library, limited to the last 10 years, with the terms: bladder cancer, recurrence, detection and urine marker. 973 registers were obtained, and 27 publications were selected following the PRISMA recommendations.

Evidence synthesis

The negative predictive values (NPV) of several assays could reduce the number of cystoscopies in NMIBC surveillance. Six transcription-factor trials had an NPV rate greater than 90%, and one of them can be performed at the control point. Six transcription-factors evaluations describe anticipated diagnosis between 68% and 83% of their “false positives”. Two transcription factors and one protein assays proved reduction between 23% and 35% of surveillance cystoscopies. Nowadays, cell-based assays are restricted to reflex test after doubtful cytologies.

Conclusion

There are few studies analysing the improvement of the NMIBC surveillance protocols. Several transcription factor assays are more precise and allow anticipatory diagnosis. Currently, there are no comparative studies between alternative surveillance protocols and classic ones.

Keywords:
Bladder cancer
Biomarker
Surveillance
Urine
Resumen
Contexto

La vigilancia del tumor vesical no músculo infiltrante (TVNMI) se realiza habitualmente mediante cistoscopia y citologías urinarias seriadas. Hoy, no se utiliza ningún marcador urinario, suficientemente eficaz, para reducir la morbilidad y coste de este seguimiento.

Objetivo

Describir el rendimiento de los marcadores urinarios en la vigilancia del TVNMI.

Adquisición de la evidencia

El 1 de agosto de 2018 se realizó búsqueda bibliográfica en Pubmed, Embase y librería Cochrane, acotada a los últimos 10 años, con los términos: bladder cancer, recurrence, detection y urine marker. Se obtuvieron 973 registros y siguiendo las recomendaciones PRISMA se seleccionaron 27 publicaciones.

Síntesis de la evidencia

Los valores predictivos negativos de varios ensayos permitirían reducir el número de cistoscopias en la vigilancia del TVNMI. Seis ensayos de factores de transcripción tuvieron un valor predictivo negativo superior al 90% y uno de ellos se puede realizar en el punto de control. Seis ensayos de factores de transcripción describen diagnóstico anticipado entre el 68% y 83% de sus «falsos positivos». Dos ensayos de factores de transcripción y uno de proteínas demuestran reducir entre el 23% y el 35% de las cistoscopias de vigilancia. Los ensayos celulares se restringen a pruebas reflejo ante citologías urinarias dudosas.

Conclusión

Existen pocas publicaciones que permitan analizar la mejoría del protocolo de vigilancia del TVNMI. Los ensayos de factores de transcripción tienen la mejor precisión diagnóstica y algunos permiten diagnóstico anticipado. Hoy en día no hay análisis que comparen entre protocolos alternativos de vigilancia y el convencional.

Palabras clave:
Cáncer vesical
Biomarcador
Vigilancia
Orina

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