Biomarkers for Early Detection of Non-Muscle Invasive Bladder Cancer Recurrence: A Systematic Review
Keywords:
Urinary bladder neoplasms; neoplasm recurrence, local; early detection of cancer; biomarkers, tumor; cystoscopyAbstract
Introduction: Non-muscle invasive bladder cancer (NMIBC) has a 50–70% recurrence rate, necessitating frequent cystoscopies. Urinary biomarkers could reduce invasive monitoring. This review evaluates the diagnostic accuracy of promising biomarkers for NMIBC recurrence.
Methods: We searched Cochrane Library, Embase, and Scopus (2018–2024) for prospective cohort studies evaluating urinary biomarkers (protein, DNA, or RNA) against cystoscopy/histology as reference. Inclusion: adult NMIBC patients post-resection, follow-up ≥12 months. QUADAS-2 assessed risk of bias.
Results: Seventeen studies (n=2,893) reported on 12 biomarkers. UroVysion (FISH) had pooled sensitivity 72% (95%CI 66–78) and specificity 85% (80–89). Bladder EpiCheck (DNA methylation) showed sensitivity 68% (61–74), specificity 88% (83–92). Xpert Bladder Cancer Monitor (mRNA) achieved sensitivity 81% (74–87) but lower specificity 69% (63–75). Negative predictive values exceeded 90% for all three.
Discussion: Current biomarkers lack the sensitivity to replace cystoscopy for high-risk patients. Xpert misses fewer recurrences but yields more false positives. Most studies excluded carcinoma in situ, a challenging lesion. Cost-effectiveness analyses are absent.
Conclusions: Urinary biomarkers for NMIBC recurrence surveillance are adjuncts, not replacements, for cystoscopy. Xpert Bladder Cancer Monitor shows highest sensitivity. Future panels should combine methylation and mutation markers.
