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A Urine Based Genomic Assay to Triage Patients with Hematuria for Cystoscopy.

基于尿液的基因组分析对血尿患者进行膀胱镜检查。

  • 影响因子:1.46
  • DOI:10.1097/JU.0000000000000786
  • 作者列表:"van Kessel KEM","de Jong JJ","Ziel-van der Made ACJ","Roshani H","Haensel SM","Wolterbeek JH","Boevé ER","Oomens EHGM","van Casteren NJ","Krispin M","Boormans JL","Steyerberg EW","van Criekinge W","Zwarthoff EC
  • 发表时间:2020-07-01
Abstract

PURPOSE:Current clinical guidelines recommend cystoscopy in patients who present with hematuria to rule out a bladder tumor. We evaluated whether our previously developed urine assay was able to triage patients with hematuria for cystoscopy in a large prospective cohort. MATERIALS AND METHODS:A urine sample was collected before cystoscopy and mutation/methylation status of 6 genes was determined on cellular DNA. The existing diagnostic model was validated on this cohort. Logistic regression was applied to investigate other potential variables. The primary end point was the model performance as indicated by the AUC. Secondary end points were sensitivity, specificity and negative predictive value. Clinical usefulness was determined by the net benefit approach. RESULTS:In 838 patients biomarker status could be determined for all genes. Urothelial cancer was observed in 112 patients (98 of 457 in the gross and 14 of 381 in the microscopic hematuria group). Validation of the existing model resulted in an AUC of 0.93. Logistic regression analysis identified type of hematuria as a significant additional variable. Adding type of hematuria resulted in an AUC of 0.95 (96% sensitivity, 73% specificity, 99% negative predictive value). The assay identified all upper tract tumors not visible by cystoscopy (in 6). Net benefit analysis showed that the urine assay should be preferred over current clinical practice. Implementing the urine assay as a triage tool could lead to a 53% reduction in cystoscopies. CONCLUSIONS:The urine assay detected urothelial cancer with a very high accuracy and can be used to triage patients presenting with hematuria for cystoscopy.

摘要

目的: 目前的临床指南建议对血尿患者进行膀胱镜检查以排除膀胱肿瘤。我们评估了我们以前开发的尿液测定是否能够在大型前瞻性队列中对血尿患者进行膀胱镜检查。 材料和方法: 在膀胱镜检查之前收集尿样,并在细胞DNA上确定6个基因的突变/甲基化状态。现有的诊断模型在该队列中得到验证。应用Logistic回归研究其他潜在变量。主要终点是由AUC指示的模型性能。次要终点为敏感性、特异性和阴性预测值。通过净获益方法确定临床有用性。 结果: 在838例患者中,可以确定所有基因的生物标志物状态。在112例患者中观察到尿路上皮癌 (肉眼血尿组457例中的98例和镜下血尿组381例中的14例)。现有模型的验证导致0.93的AUC。Logistic回归分析确定血尿类型是一个显著的附加变量。加入血尿类型导致0.95的AUC (96% 灵敏度,73% 特异性,99% 阴性预测值)。该测定鉴定了通过膀胱镜检查不可见的所有上尿路肿瘤 (在6中)。净效益分析表明,尿液测定应优先于目前的临床实践。将尿液测定作为分诊工具实施可导致膀胱镜检查减少53%。 结论: 尿液检测尿路上皮癌具有很高的准确性,可用于对血尿患者进行膀胱镜检查。

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影响因子:2.56
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作者列表:["Renninger M","Fahmy O","Schubert T","Schmid MA","Hassan F","Stenzl A","Gakis G"]

METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

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发表时间:2020-02-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000313
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泌尿外科手术方向

泌尿系统出现一些病变,需要通过手术来治疗,这些手术就称为泌尿外科手术。

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