Potential of Urinary Mutation and Methylation Biomarkers in Selecting Candidates for Repeat Transurethral Resection
Xiao Yang1, Lingkai Cai1,2, Yaqun Xin3
1Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background And Objective:
The necessity of repeat transurethral resection of bladder tumor (re-TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remains a matter of debate. The role of liquid biopsy in predicting residual tumor status and selecting patients who can be spared re-TURBT is still undefined. The aim of our study was to assess the efficacy of the urinary OncoUrine assay for mutation and methylation markers in determining the necessity for re-TURBT in NMIBC.
Methods:
We prospectively recruited patients with NMIBC who were candidates for re-TURBT. Urine samples for OncoUrine testing and exfoliated cytology analysis were collected after initial TURBT, followed by re-TURBT.
Key Findings And Limitations:
Among 151 patients with NMIBC, 48 (32%) had residual tumor at re-TURBT, and 87 (58%) had detrusor muscle (DM) in their initial TURBT specimen. The OncoUrine test showed sensitivity of 77%, specificity of 78%, positive predictive value of 62%, and negative predictive value (NPV) of 88% for residual tumor, while exfoliated cytology showed corresponding values of 20%, 96%, 69%, and 72%. Stratified analyses revealed higher OncoUrine accuracy in predicting disease-free status in intermediate-risk NMIBC (NPV 98%) and in high-risk NMIBC cases with DM in the initial TURBT specimen (NPV 92%). At 18-mo follow-up for 131 patients, 20 had experienced tumor recurrence, for which OncoUrine positivity was the only independent factor predictive for the risk of recurrence (hazard ratio 3.67, 95% confidence interval 1.49-9.00; p = 0.005).
Conclusions And Clinical Implications:
The OncoUrine test may identify patients who can avoid unnecessary re-TURBT, especially for intermediate-risk NMIBC cases and high-risk NMIBC cases with DM in the initial TURBT specimen. Conversely, patients with a positive OncoUrine result are at higher risk of recurrence and should undergo re-TURBT.
Patient Summary:
OncoUrine is a urine test that can help in identifying patients with non-muscle-invasive bladder cancer who may be able to avoid unnecessary repeat resection of the bladder.
