Testing for urinary hyaluronate improves detection and grading of transitional cell carcinoma

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dc.contributor.authorPasserotti, Carlo C. [UNIFESP]
dc.contributor.authorSrougi, Miguel
dc.contributor.authorBomfim, Alexandre C. [UNIFESP]
dc.contributor.authorMartins, Joao Roberto M. [UNIFESP]
dc.contributor.authorLeite, Katia R. M.
dc.contributor.authorReis, Sabrina T. dos
dc.contributor.authorSampaio, Lucia O. [UNIFESP]
dc.contributor.authorOrtiz, Valdemar [UNIFESP]
dc.contributor.authorDietrich, Carl P. [UNIFESP]
dc.contributor.authorNader, Helena B. [UNIFESP]
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:17:25Z
dc.date.available2016-01-24T14:17:25Z
dc.date.issued2011-11-01
dc.description.abstractObjective: the purpose of this study is to establish a method for the diagnosis and grading of transitional cell carcinoma (TCC), which is responsible for 90% of bladder tumors, using a recently developed ultrasensitive assay for the measurement of hyaluronan (HA).Materials and methods: Urine samples were collected prior to surgery (cystoscopy, transurethral resection for bladder cancer (TURBT), and cystectomy) in 350 patients. After the procedure, pathologic examination revealed that 160 patients had TCC. HA was measured directly in the urine by a noncompetitive enzyme-linked immunosorbent assay (ELISA)-like fluorometric assay. Using the receiver operator characteristic curve (ROC), t-test, Dunn test, Kruskal-Wallis test, and Mann-Whitney test, we evaluated the differences between groups (those with TCC vs. those without TCC).Results: By analyzing the ROC curve, we chose a urinary HA cutoff value of 13.0 mu g/l for indicating risk of TCC. Using the value this of 13.0 mu g/l, we found that this test had an overall sensitivity of 82.3% and an overall specificity of 81.2%. the positive predictive value of this assay was 78.9%, the negative predictive negative value was 84.2%, and the predictive accuracy was 81.7%. Logistic regression analysis revealed that every 1 mu g/l increase in HA increased a patient's likelihood of having TCC by 3.9%. the sensitivity of this test to detect superficial tumors was 76.6%, whereas its sensitivity for detecting invasive tumors was 94.6%. the urinary HA excretion of patients with TCC, classified according to the TNM staging system and the World Health Organization (WHO) grading system, were compared, and a significant difference was observed between the HA levels of patients with superficial tumors compared with invasive tumors (P = 0.005) as well as between patients with low- vs. high-grade carcinomas (P < 0.001). Patients with urinary HA levels >35 mu g/l had a 4.63 times increased risk of having an aggressive, invasive, high grade tumor (P = 0.005).Conclusions: Our results support the postulate that urinary HA may be used as a tumor marker to aid in the diagnosis and grading of TCC. Additionally, more invasive tumors produce and release more HA in urine than superficial tumors, thus higher HA levels indicate more aggressive disease. (C) 2011 Elsevier Inc. All rights reserved.en
dc.description.affiliationUniv São Paulo, Fac Med, Dept Urol, Lab Med Invest LIM55, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Dept Urol, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Dept Mol Biol, São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Dept Endocrinol & Metabol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Dept Urol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Dept Mol Biol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Dept Endocrinol & Metabol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.format.extent710-715
dc.identifierhttp://dx.doi.org/10.1016/j.urolonc.2009.10.006
dc.identifier.citationUrologic Oncology-seminars and Original Investigations. New York: Elsevier B.V., v. 29, n. 6, p. 710-715, 2011.
dc.identifier.doi10.1016/j.urolonc.2009.10.006
dc.identifier.issn1078-1439
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34203
dc.identifier.wosWOS:000297443300018
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofUrologic Oncology-seminars and Original Investigations
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.subjectUrinary hyaluronanen
dc.subjectTumor markeren
dc.subjectTransitional cell carcinomaen
dc.subjectHuman bladder neoplasmsen
dc.titleTesting for urinary hyaluronate improves detection and grading of transitional cell carcinomaen
dc.typeinfo:eu-repo/semantics/article
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