Prospective Validation of an mRNA-based Urine Test for Surveillance of Patients with Bladder Cancer.
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Valenberg F Johannes P van, Hiar Andrew M, Wallace Ellen, Bridge Julia A, Mayne Donna J, Beqaj Safedin, Sexton Wade J, Lotan Yair, Weizer Alon Z, Jansz Godfrey K, Stenzl Arnulf, Danella John F, Shepard Barry, Cline Kevin J, Williams Michael B, Montgomery Scott, David Richard D, Harris Richard, Klein Eric W, Bradford Timothy J, Wolk Fred N, Westenfelder Karl R, Trainer Andrew F, Richardson Timothy A, Egerdie Russell B, Goldfarb Bernard, Zadra Joseph A, Ge Sijian, Zhao Suling, Simon Iris M, Campbell Scott A, Rhees Brian, Bates Michael P, Higuchi Russell G, Witjes J Alfred
Аннотация
OBJECTIVE: To validate Xpert characteristics in patients previously diagnosed with non-muscle-invasive BC.
DESIGN, SETTING, AND PARTICIPANTS: Voided precystoscopy urine samples were prospectively collected at 22 sites. Xpert, cytology, and UroVysion were performed. If cystoscopy was suspicious for BC, a histologic examination was performed. Additionally, technical validation was performed and specificity was determined in patients without a history or clinical evidence of BC.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Test characteristics were calculated based on cystoscopy and histology results, and compared between Xpert, cytology, and UroVysion.
RESULTS AND LIMITATIONS: Of the eligible patients, 239 with a history of BC had results for all assays. The mean age was 71 yr; 190 patients were male, 53 never smoked, and 64% had previous intravesical immunotherapy (35%) or chemotherapy (29%). Forty-three cases of recurrences occurred. Xpert had overall SN of 74% (95% confidence interval [CI]: 60-85) and 83% (95% CI: 64-93) for high-grade (HG) tumors. The NPV was 93% (95% CI: 89-96) overall and 98% (95% CI: 94-99) for HG tumors. Specificity was 80% (95% CI: 73-85). Xpert SN and NPV were superior to those of cytology and UroVysion. Specificity in non-BC individuals (n=508) was 95% (95% CI: 93-97).
CONCLUSIONS: Xpert has an improved NPV compared with UroVysion and cytology in patients under follow-up for BC. It represents a promising tool for excluding BC in these patients, reducing the need for cystoscopy.
PATIENT SUMMARY: Xpert is an easy-to-perform urine test with good performance compared with standard urine tests. It should help optimize the follow-up of recurrent bladder cancer patients.