الفهرس 
BLADDER CANCEROnly 14 pages are availabe for public view
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Abstract
Bladder cancer represents a global health problem. It is one of the most common urologic malignancies ranking the fourth in males and the tenth in females worldwide. Currently used bladder screening and diagnostic tools for patients with gross or microscopic hematuria include urine cytology and cystoscopy. Although being a simple, non-invasive and highly specific technique, cytology has an overall low sensitivity. Cystoscopy is the primary diagnostic modality for diagnosing bladder cancer. However, it is an invasive procedure, relatively expensive. It may also fail to detect CIS. These concerns have driven the search for other non-invasive, less expensive and more reliable markers for this disease. Among these is Alpha 1-Antitrypsin (A1AT) is a protease inhibitor belongs to the serpin superfamily; located on chromosome 14q32.1, it plays a major role in the normal physiological processes such as angiogenesis and intravascular fibrinolysis. However, it may also participate in pathological conditions such as tumor invasion and metastasis which require degradation of the basement membrane, stimulation of angiogenesis, and migration. Aim of the work: The aim of this study was to assess the clinical utility of urinary alpha1- antitrypsin as a non- invasive tool for early detection of bladder cancer patients and their prognostic role through their association with different histopathological stages and grades of the disease. Subjects and Methods: This study was conducted on fifty (50) bladder cancer patients, twenty (20) pathological control patients and fifteen (15) apparently healthy subjects serving as a control group, all of whom willingly participated in the study. All studied individuals were subjected to the following: Thorough history taking, with special focusing on smoking and bilharzial infestation, Histopathological examination for patient group only, Complete urine analysis, Urine cytology, Estimated GFR (eGFR) and Urinary A1AT measurement by enzyme linked immunosorbent assay (ELISA) technique. Results: Our results revealed that urinary A1AT provided a much higher sensitivity than urine cytology in the diagnosis of bladder cancer, When ROC curve analysis was applied to urinary A1AT in bladder cancer patients versus healthy controls revealed that diagnostic sensitivity 96%, specificity 100%, positive predictive value 100%, negative predictive value 88.2% and diagnostic efficacy 96.9% and urinary A1ATin bladder cancer patients versus pathological controls revealed that diagnostic sensitivity 94%, specificity 100%, positive predictive value 100%, negative predictive value 87% and diagnostic efficacy 95.7%. Conclusion: The results of this study confirm the need for a new diagnostic tool to improve the low sensitivity of urine cytology in bladder cancer. Urinary A1AT provided a much higher sensitivity than urine cytology. This higher sensitivity with 100% specificity render a urinary A1AT is a promising non-invasive marker for this disease. Also, the significant increase of urinary A1AT with tumor stages and grades suggests that it is an indicator of disease prognosis.