Nuclear Matrix Protein 22 And Hyaluronic Acid In The Detection Of Bladder Cancer

Bladder carcinoma is the most common seen tumor in urinary tract.More than 90% of bladder carcinoma is transitional cell carcinoma(TCC).More than 80% of TCC of the bladder is superficial bladder carcinoma(SBC).Recurrence of TCC of the bladder is high.More than 50% to 90% of SBC recur within 5 years while 10% to 20% progress to invasive disease. Successful management depends on regular follow-up and early detection of persistent or recurrent carcinoma.The most accepted surveillance for patients is based on urinary cytology and cystoscopy .The sensitivity of the former is low as and the latter is traumatic. The potential development of highly sensitive and specific markers for the detection of TCC of the bladder could have an impact on improving effectively diagnosis and management,as well as reducing the number of cystoscopies and the mortality of the bladder carcinoma .Despite there being well difined criteria for the grading of SBC(90%SBC is G1 or G2),many reports have shown 30% to 40% variability among pathologists.The development of objective markers to predict the recurrence of the SBC has important clinical significance in establishing treatment and follow-up protocal.In recent years,NMP-22 and HA are potential diagnostic markers for TCC of the bladder have been reported .Some reports appeared that the NMP-22 test had high sensitivity, however,another reports did not appear to be.There is disputation in determine the HA test in diagnostic value of bladder cancer.There is less report about comprehensive comparison dignostic values of urinary NMP-22 and HA in bladder cancer.This perspective clinical study compared the diagnostic values of NMP-22,HAand urinary cytology with UC by means of ELISA and RI methods and so on. As Cystoscope and biopsy gold standard,we assess the dignostic values of three tests without trauma in the detection of bladder cancer.ObjectiveTo assess the clinical value of NMP-22 and HAin the detection of bladder cancer. To assess the dignostic values of NMP-22,HA and urine e×foliative cytology in the detection of bladder cancer.MethodsSubjects ,including 35 bladder cancer patients ,20 urological benign disease patients and 10 normal (healthy) individuals who are received urine e×foliative cytology test were enrolled in this study.Urine NMP-22 was assesed by enzyme-linked immuno sorbent assay (ELISA) and HA by radioimmunology assay before cystoscopy. 35 bladder cancer patients are included 28 Tis~T1,7 T2~T4.All subjects are received urine NMP-22 ,HA and urinarycytology before cystoscope test. we assess the sensitivity,specificity,respectively predictive values , positive predictive values of three tests in the study.ResultsThe median of NMP-22 were as follows: bladder cancer patients 33.8 U/mL, urological benign disease patients 7.8U/mL and normal (healthy) individuals 4.8 U/mL.The first two were more than the last(P<0.01). The median of NMP-22 of bladder cancer patients who were in diffirent clinical stage had no significant difference (P>0.05). The pathology of bladder cancer and the content of NMP-22 had positive correlation in midrange(rs=0.651,P<0.001); The content of HA were as follows: bladder cancer patients (376. 8±50. 4) ng/ ml L, urological benign disease patients (128. 5±16. 2) ng/ ml和and normal (healthy) individuals (80.7±22.8)ng/ ml.The first was more than the later two(P<0.01). The content of HA of Tis ~T1 group and T2~T4 group had no significant difference(P<0. 01). The pathology of bladder cancer and the content of HA had positive correlation in midrange (rs=0.672,P<0.001); The sensitivity,specificity,respectively predictive values and positive predictive values of NMP-22 were 62.9%,80.0 %,78.6%,64.9%.The content of NMP-22 had no significant difference in diffrerent grade or stage of bladder cancer (P>0.05). The sensitivity,specificity,respectively predictive values and positive predictive values of HA were 68.6%,76.7%,77.4%,67.7%.The sensitivity of HA of G2,G3 group were more than G1 group (P<0. 01),and the first two had no significant difference (P>0.05); The sensitivity,specificity,respectively predictive values and positive predictive values of urinary cytology were 20.0%,96.7%,87.5%,50.9%.The sensitivity of NMP-22 test or HA test were significantly better than urinary cytology test,but the specificity were lower . The sensitivity of NMP-22 and HA jointly were 88.4%.ConclusionsThe study indicates that NMP-22 and HA aresensitive , specificity , simple , feasible and noninvasive diagnostic markers for the early detection of urinary bladder cancer.(1) NM-P22 and HA are diagnostic markers in the detection of bladder cancer. (2) The content of NMP-22 was related to pathology of bladder cancer.(3)To initial patients, the critical value of NMP-22 properly was 10×103U/L .(4) The sensitivity of NMP-22 and HA were significantly better than urinarycytology. (5)The content of NMP-22 had no significant difference in diffrerent grade or stage of bladder cancer . The sensitivity of G2,G3group were better than G1 group in HA test .(6) Urine NMP-22 and HA joint test raised the sensitivity of the diagnosis in bladder cancer.