Considerations on implementing diagnostic markers into clinical decision making in bladder cancer
Considerations on implementing diagnostic markers into clinical decision making in bladder cancer
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DOI：
10.1016/j.urolonc.2009.11.004
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发表时间：
2010-07-01
影响因子：
2.7
通讯作者：
Grossman, H. Barton
中科院分区：
文献类型：
--
作者：
Lotan, Yair;Shariat, Shahrokh F.;Grossman, H. Barton
膀胱癌是一种常见的疾病，往往发现晚，复发率和进展率高。膀胱镜检查是检测和监测膀胱癌的主要工具，但具有侵入性，可能会遗漏一些癌症。细胞学是经常使用的，但具有较差的灵敏度。目前有几种市售的尿液肿瘤标志物，但指南小组不推荐使用。诸如Urovysion FISH检测试剂盒和NMP22 BladderChek检测试剂盒等标志物已被批准用于血尿患者的监测和检测。这些标记物和其他市售标记物（例如Ucyt+、BTA stat）的额外益处尚未得到充分研究，尽管这些标记物似乎不够灵敏，无法取代膀胱镜检查。需要进行更多的研究来确定膀胱标记物最佳利用的临床情况（筛查，监测，早期检测，评估细胞学检查）以及它们对临床决策的影响。此外，各种问题和障碍可能会影响临床试验从研究到临床实践的发展。本文讨论了研究和医学界在膀胱癌诊断标志物的提供和整合方面面临的一些挑战。此外，我们试图概述新的膀胱癌诊断标志物的临床实用性的标准。(c)2010年爱思唯尔公司All rights reserved.
Bladder cancer is a common disease that is often detected late and has a high rate of recurrence and progression. Cystoscopy is the main tool in detection and surveillance of bladder cancer but is invasive and can miss some cancers. Cytology is frequently utilized but suffers from a poor sensitivity. There are several commercially available urine-based tumor markers currently available but their use is not recommended by guideline panels. Markers such as the Urovysion FISH assay and the NMP22 BladderChek test are approved for surveillance and detection in patients with hematuria. The added benefit of these markers and other commercially available markers (e.g. Ucyt+, BTA stat) has not been well investigated though it appears these markers are insufficiently sensitive to replace cystoscopy. Additional studies are needed to determine the clinical scenarios where bladder markers are best utilized (screening, surveillance, early detection, evaluating cytologic atypia) and what impact they should have on clinical decision making. Furthermore, a variety of issues and barriers can affect the movement of clinical tests from research to clinical practice. This article addresses some of the challenges facing research and medical communities in the delivery and integration of markers for bladder cancer diagnosis. Moreover, we attempt to outline criteria for the clinical utility of new bladder cancer diagnostic markers. (c) 2010 Elsevier Inc. All rights reserved.