Image: A histopathology of urothelial carcinoma of the urinary bladder (Photo courtesy of Wikimedia Commons).
A test that detects a specific enzyme in the urine is able to predict the likelihood of recurrence of disease in patients that have been treated for bladder cancer.
Urothelial bladder cancer (UBC) is characterized by a high risk of recurrence. Patient monitoring is currently based on iterative cystoscopy and on urine cytology that has low sensitivity in non-muscle-invasive bladder cancer (NMIBC). The enzyme telomerase reverse transcriptase (TERT) is frequently reactivated in UBC patients by promoter mutations.
Investigators at University Hospital of Lyon (France) examined whether detection of TERT mutation in urine could be a predictor of UBC recurrence and compared this to cytology/cystoscopy for patient follow-up. A total of 348 patients treated by transurethral bladder resection for UBC were included in the study together with 167 control patients.
Results revealed that overall sensitivity of the TERT assay was 80.5% and specificity 89.8%. These parameters were not greatly impacted by inflammation or infection. In contrast, cytology detected recurrence in only 34% of patients. Urine samples that were TERT positive from patients after initial surgery were associated with residual cancer cells in the body. Thus, TERT in urine was a reliable and dynamic predictor of recurrence in NMIBC.
Senior author Dr. Alain Ruffion, professor of urology at the University Hospital of Lyon, said, "The standard cytology test needs a doctor to look down a microscope to read the results, but the TERT test is read by a machine which is simpler, more accurate, and available to use straightaway. While the TERT test costs slightly more than standard cytology, it is likely to become cheaper over time. The fact that the test does not react to urinary tract infections is very interesting because it shows that it is robust and unlikely to give misleading results."
The TERT study was published in the July 6, 2017, online edition of the British Journal of Cancer.
University Hospital of Lyon