Role of cytokeratin 19 fragment (Cyfra 21-1); n•uclear matrix protein (NMP22), urinary bladder cancer antigen (UBC) & tissue polypeptide antigen (TPA) as diagnostic, non-invasive tools in urinary bladder cancer

Abstract

Urinary bladder cancer is among the 10 most frequent cancers worldwide. Diagnostic procedures include urine cytology, cystoscopy and biopsy that is by far the main diagnostic tool. Aim of this work was to evalute the diagnositic value of urinary tumor markers Cyfra 21-1. UBC and NMP22 and the serum marker TPA in urinary bladd_ cancer patients as non-invasive diagnostic tools for urinary blaader cancer patients. The work was done on a total number of 80 subject. 50 urinary bladder cancer patients. 10 urinary bladder cancer follow up cases. completely free of the disease as confirmed by cystoscopy and 20 heallhy controls. Random urine and blood samples were collected from all subiects. The three urinary markers assayed in this work were Cyfra 21- I (Eiectrochemiluminescent immunometric assay, Roche Diagnostics). UBC {immunoradiometric assay. IDlBiotech). NMP22 (chemiluminescent ezyme immunometric assay,Matritech) and the serum marker TPA (immunoradiometric assay, IDL Biotech). Combination of more than one markers yeilded a higher sensitivity and diagnostic accuracy than single marl<.er determination. Combination of NMP22 and UBC yeilded a sensitivity to 94% and and a diagnostic accuracy of 95%. Combination of Cyfra 21-1 with NMP22 yeilded a sensitivity' of 90% diagnostic accuracy of 92.5%. Combination of Cyfra 21-1 with UBC yeilded a sensitivity of 90% and a diagnostic accuracy of 93.7%. Combination of the three urinary markers yeilded a sensitivity Qf 94% and diagnostic accuracy of 96.2%. All combinations yeidled a specificity approaching 97% aHer the exclusion criteria are tal<.en into consideration.' While isolated markers showed sensitivity of 78% for Cyfra 21-1. 86% for UBC and 88.% for NMP22, and 26% for TPA. Based on these findings we say that combined marker determination is a highly valuable tool recommended for diagnosis and screening of urinary bladder cancer patients . The same applies for follow up cases with cystoscopy reserved for cases with positive marker values.The recommeded screening program for urinary bladder cancer that would target the high risl<. population is : a combination of two markers preferably NMP22 and a cytokeratin. UBC or Cyfra 21-1 with microscopic examination of urine or dipstick testing to avoid a false positive • result attributed to urinary tract infection.