Background: Determination of tumor markers in body fluids lining the tumor should provide more reliable information on the malignancy, since dilution, metabolism and execration have very limited, if any, effect on the actual marker concentration, which makes urine the ideal candidate for bladder malignancies.
The present work aimed to evaluate the role of Tumor-Associated Trypsin Inhibitor (TATI), Cytokeratin Fragment Antigen (CYFRA) 21.1, Nuclear Matrix Protein 22 (NMP-22) and Tumor Polypeptide-Specific (TPS) Antigen in urine as potential diagnostic and prognostic markers for bladder cancer, in relation to urine cytology.
The study included 3 groups. Group 1 comprised of 60 patients with primary bladder cancer, group 2 composed of 40 patients with benign urologic diseases and group 3 included 40 healthy volunteers of matching age and sex as a control group. From each subject, one random midstream urine sample was collected before endoscopy. TATI, CYFRA 21.1 and TPS were assayed by radioimmunomertry while NMP-22 was assayed by ELISA. Patients were followed up for 36 months.
Mean levels of all measured parameters were significantly higher in bladder cancer group than those in benign and control groups. ROC curves showed that they were all of diagnostic significance, and at cutoff values of 42 g/g cr, 21 g/g cr, 10.5 U/g cr and 152 IU/g cr; respectively, TATI, CYFRA 21.1, NMP-22 and TPS had sensitivities of 82.0%, 80.4%, 73.9% and 68.2% and specificities of 80.5%, 73.1%, 72.4% and 61.5%; respectively. Patients with elevated initial levels of markers at presentation than their respective cutoff values had significantly lower disease-free survival (DFS), also DFS decreased as the number of positive markers increased.
In bladder cancer patients, initial urinary levels of TATI, CYFRA 21.1, NMP-22 and TPS at presentation were significant diagnostic markers with acceptable sensitivities and specificities, and also were significant prognostic markers. When these four markers were joined, DFS declined as the number of positive markers increased.