الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Summary & Conclusion
Summary and Conclusions
Bladder cancer· is considered the fourth highest new cancer
diagnosis in men in the United States.
In Egypt, the unnary bladder malignancy represents a high
incidence 01’26.4% of total malignant tumors.
While transitional cell carCInoma IS the predominating
histopathologic type of cancer bladder in western countries, squamous
cell carcinoma is the most common type in Egypt repn:senting an
incidence of 58.4% of all bladder tumors.
Bladder tumors are classically diagnosed by cystoscopy. The
procedure represents the highest valuable standard for detection and
monitoring but it is invasive and expensive.
Urinary cytology is a long established non-invasive and very
effective in diagnosing high grade lesions but it has a low sensitivity in
detecting grade I tumors which are the most common type of UCC.
The limitations of cytology and cystoscopy, both for primary
diagnosis and monitoring of patients after VCC has been removed led to
the development of new urinary bound tests for the early detection of
UCc.
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Summary & Conclusion
Among these, there are NMP22 which has recently been approved
by the Food and Drug Administration for bladder cancer evaluation and
UBC antigen which measures urinary fragments ofcytokeratins 8/18.
The aim of this work is to evaluate urinary bladder cancer (UBC)
antigen and urinary nuclear matrix protein 22 (NMP22) as new noninvasive
tumor markers in diagnosis of squamous cell carcinoma of the
bladder.
This study included 60 patients diagnosed by histopathology
following cystoscopic biopsy to have squamous cell carcinoma of the
bladder (group I), 15 patients with other benign urologica. conditions
(group II) and finally 15 apparently healthy controls (group Ill).
The patients and control persons were subjected to the following:
-Complete history taking including:
Age, sex and presence of hematuria.
-Clinical examination:
Patients of group I were subjected to PR examination and cystoscopy, and
the cystoscopic findings with confirmatory biopsies were considered the
gold standard for diagnosis.
-Laboratory assays:
Urine samples from the patients and control persons were subjected to the
following:
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Summary & Conclusion
1. Compl te urine examination especially for pus cells and RBCs.
2. Urina creatinine measurement.
3. Detect on ofNMP22.
4. Detec on of urinary bladder cancer (UBC) antigen.
The esults of this study were summarized as the folio wing:
1_At a cut iff value of greater than 7 Ulml (determined from ROC curve)
for NMP22; maximum sensitivity (76.67%), specificity (80%),
positive predictive value (88.46%), negative predictive value
(63.16%) and accuracy (77.78%) were observed.
2- Upon correction ofNMP22 for creatinine concentration, the threshold
from ROC analysis was 5 U/mg. creatinine. The sensitivity (83.33%)
and specificity (83.33%) were slightly higher but not significantly
different from the uncorrected estimate.
3- Group I showed highly significant increase in median NMP22 as
compared to both group II and group III (P <0.001).
4- At a cutoff value of greater than 7.5 llg/I (determined from ROC
curve) for UBC, maximum sensitivity (85%), specificity (85%),
positiv e predictive value (92.73%), negative predictive value
(74.29%) and accuracy (85.56%) were observed.
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Summary & Conclusion
5- Upon cor·ection of UBC for creatinine concentration, the threshold
from ROC analysis was 6 !!g/grn. creatinine with no change in both
sensitivir I and specificity.
6- Group I showed highly significant increase in median UBC as
compared to both group II and group III (P <0.001).
7- UBC was found to be more sensitive (85% versus 76.67%) and more
specific :86.67% versus 80%) than NMP22.
8- When clliculating the combined measurement ofUBC and NMP22,
we found NMP22 to increase the sensitivity (88.3%), specificity
(86.7%), positive predictive value (92.9%), negative predictive value
(78.8%: and accuracy (87.8%) ofUBC.
9- When c4lrrelating all parameters with each other we found that:
-There was positive significant correlation between ’~P22 and
UBC among patients in group I.
-There was positive non-significant correlation between NMP22
and UBC among patients in group II.
-Th ere was negative non-significant correlation between NMP22
and UBC among healthy subjects in group III.
In conclusion:
Tho preliminary results of this study indicate that the urinary
bladder cancer antigen and nuclear matrix protein 22 can potentially be
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Summary & Conclusion
incorporated into a biomarker profile for the detection and monitoring of
bladder cancer.
There was a statistical difference in UBC and NMP22 in patients
with eviden~e of cancer bladder compared to those with no evidence of
the disease. The higher sensitivity and specificity ofUBC suggest that it
performs better than NMP22 and it may replace cytology as an adjunct to
cystoscopy n diagnosis and follow up of bladder cancer cases.