Zie ook literatuurlijst van voeding, niet-toxische middelen en weinig belastende behandelingen specifiek bij blaaskanker van arts-bioloog drs. Engelbert Valstar.  

7 augustus 2022: Zie ook dit artikel: https://kanker-actueel.nl/biomarker-ercc1-voorspelt-overlevingskansen-voor-blaaskanker-en-of-chemo-vooraf-aan-operatie-cystectomie-nodig-is.html

7 augustus 2022: Bron: Front. Surg., 28 September 2021 Sec. Genitourinary Surgery

In dit artikel een reviewstudie over biomarkers bij  niet-spierinvasieve blaaskanker. De onderzoekers hebben een samenvatting gemaakt van 6 door de Amerikaanse Food and Drug Administration (FDA) goedgekeurde eiwit biomarkers, samen met nieuwe testen die gebruikmaken van genetische markers, epigenetische markers en exosomale markers. Zij bespreken de kracht van de bewijzen van de belangrijkste beschikbare testen. 

De FDA heeft momenteel 6 urinetests goedgekeurd om naast cystoscopie te gebruiken voor diagnose en toezicht bij niet-spier-invasieve blaaskanker. Deze omvatten BTA stat (Polymedco), BTA TRAK (Polymedco), NMP22 enzyme-linked immune-sorbent assay (ELISA) (Matritech), NMP22 BladderChek Test (Alere), uCyt (Scimedx) en UroVysion (Abbott Molecular). Deze testen kijken naar heel veel specifieke biomarkers, waaronder dus genetische markers, epigenetische markers en exosomale markers uit urinemonsters gehaald en zeer snel beschikbaar.

Het artikel is zo uitgebreid dat u beter naar het artikel zelf kunt gaan voor de beschrijvingen en de belangrijkste studies.

Klik op de titel van het abstract en bekijk ook de referentielijst daaronder:

REVIEW article

Front. Surg., 28 September 2021
Sec. Genitourinary Surgery
https://doi.org/10.3389/fsurg.2021.735868
This article is part of the Research Topic

Recent Advances in Bladder Cancer Diagnosis and Treatment

Biomarkers in Bladder Cancer Surveillance

Sukumar S. Sugeeta1Anand Sharma1Kenrick Ng1Arvind Nayak2 and Nikhil Vasdev2,3*
  • 1Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
  • 2Department of Urology and Surgery, Lister Hospital, East and North Herts NHS Trust, Stevenage, United Kingdom
  • 3School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom

Aim: This is a narrative review with an aim to summarise and describe urinary biomarkers in the surveillance of non-muscle-invasive bladder cancer (NMIBC). It provides a summary of FDA-approved protein biomarkers along with emerging ones which utilise genetic, epigenetic and exosomal markers. We discuss the current limitations of the available assays.

Background: Current guidelines advice a combination of cystoscopy, imaging,and urine cytology in diagnosis and surveillance. Although cytology has a high specificity, it is limited by low sensitivity particularly in low grade tumours. There are six FDA-approved urinary assays for diagnosis and surveillance of bladder cancer. They have shown to improve sensitivity and specificity to be used alongside cytology and cystoscopy but have a lower specificity in comparison to cytology and false positives often occur in benign conditions. Recent developments in laboratory techniques has allowed for use of markers which are RNA-, DNA-based as well as extracellular vesicles in the past decade.

Methods: Using the PubMed/Medline search engines as well as Google Scholar, we performed an online search using the terms “bladder cancer,” “non-muscle invasive bladder cancer,” and “urine biomarkers” with filter for articles in English published up to May 2021. Systematic reviews and original data of clinical trials or observational studies which contributed to the development of the biomarkers were collated.

Results: Biomarkers identified were divided into FDA-approved molecular biomarkers, protein biomarkers and gene-related biomarker with a table summarising the findings of each marker with the most relevant studies. The studies conducted were mainly retrospective. Due to the early stages of development, only a few prospective studies have been done for more recently developed biomarkers and limited meta-analyses are available.Therefore a detailed evaluation of these markers are still required to decide on their clinical use.

Conclusion: Advancements of analytical methods in BC has driven the research towards non-invasive liquid-based biomarkers in adjunct to urine cytology. Further large prospective studies are required to determine its feasibility in a clinical setting as they are not effective when used in isolation as they have their limitation. With the ongoing pandemic, other than reduction in costs and increased accuracy, the need for biomarkers to cope with delay in cystoscopies in diagnosis and surveillance is crucial. Thus clinical trials with direct comparison is required to improve patient care.


Conclusion

This paper has highlighted the various biomarkers in urothelial cancer and their significance in early diagnosis of bladder cancer. Whilst it's important to have biomarkers in NMIBC, differences in sensitivity and specificity limits their use in the community. These biomarkers have a significant role in future diagnosis of bladder cancer, and future studies will guide clinicians in using the most appropriate marker for screening. The advancement in analytical methods in BC has driven the research towards non-invasive liquid-based biomarkers in adjunct to urine cytology. This paper provides evidence that a second modality of screening tool may be beneficial to use in the diagnostic algorithm for bladder cancer. Studies identifying its feasibility in a clinical enviroment is important as they have limitations when used in isolation. Given this is a narrative review, further evaluation of these promising markers is required in more depth in terms of a meta-analysis along with the development of prospective studies in a surveillance setting. Meta-analyses on the newer markers have not been conducted as there is variability in patient cohorts utilised and more studies need to be conducted to obtain sufficient data. In addition to this, majority of studies are in a restrospective setting and prospective studies need to be developed to be able to further evaluate their clinical feasibility.

The ongoing pandemic has further accentuated the increasing need and relevance for biomarkers to cope with delay in cystoscopies in both diagnosis and surveillance. The use of more sensitive methods to detect true tumour recurrences could also play a role in assessment of the diagnostic accuracy of these markers, potentially reducing the number of cystoscopies for test-negative cases and introducing methods like blue light cystoscopy for test-positive cases. Further large, prospective clinical trials incorporating these biomarkers and usage of newer analytical methods in screening for high-risk patients and also in disease recurrence in will allow for its use in a clinical setting.

Author Contributions

SS collated and summarised studies to write up majority of this review. KN and AN were involved in editing. AS and NV contributed to the introduction and conclusion. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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