Investig Clin Urol.  2019 Sep;60(5):343-350. 10.4111/icu.2019.60.5.343.

Improving the diagnosis of high grade and stage bladder cancer by detecting increased urinary calprotectin expression in tumor tissue and tumor-associated inflammatory response

• Sahin Y
• Yucetas U
• Ates HA
• Erkan E
• Yucetas E
• Temiz MZ
• Toktas MG
• Kadihasanoglu M
• Topkaya BC

• KMID: 2455961
• DOI: http://doi.org/10.4111/icu.2019.60.5.343

Abstract

PURPOSE
To investigate whether measurement of urinary calprotectin can serve as a biomarker in the diagnosis of primary bladder cancer and to confirm its diagnostic role in determining high grade and stage disease.
MATERIALS AND METHODS
Urinary calprotectin was measured in spot urine samples from patients with primary bladder cancer and control subjects. To confirm levels in urine, tissue samples were also obtained from bladder tumor and healthy trigone of bladder by transurethral resection in both groups. Finally, calprotectin levels in tissue and urine of the patients and control subjects were compared and their diagnostic potential was investigated in high grade and stage bladder cancers.
RESULTS
Of 82 participants, 52 were patients with bladder cancer and 30 were control subjects. The two groups were comparable in terms of age, smoking status, and comorbidities. Tissue and urinary calprotectin levels were significantly higher in the bladder cancer group. In subgroup analyses, urinary calprotectin levels were significantly higher in patients with high-grade, muscle-invasive tumors. After receiver operating characteristic analyses, the sensitivity and specificity of urinary calprotectin was 100% and 96.7%, respectively, in the diagnosis of primary bladder cancer. High grade and stage bladder cancers were detected with sensitivity and specificity of 70% and 74.2%, and 80% and 84.8%, respectively.
CONCLUSIONS
Urinary calprotectin may be a valuable parameter in the diagnosis of primary bladder cancer with high sensitivity and specificity. Furthermore, it may be useful in the prediction of high grade and stage disease. However, more investigations are needed.

Keyword

Biomarkers; Calprotectin; Urinary bladder neoplasms; Urine

MeSH Terms

Biomarkers
Comorbidity
Diagnosis*
Humans
Leukocyte L1 Antigen Complex*
ROC Curve
Sensitivity and Specificity
Smoke
Smoking
Urinary Bladder Neoplasms*
Urinary Bladder*
Biomarkers
Leukocyte L1 Antigen Complex
Smoke

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curve analysis of urinary and tissue calprotectin levels in the diagnosis of primary bladder cancer (area under the curve [AUC]=0.976, 95% confidence interval [CI], 0.929–1.023, p<0.0001; AUC=0.713, 95% CI, 0.579–0.847; respectively, for urinary and tissue calprotectin levels).

• 

  Fig. 2 Receiver operating characteristic (ROC) curve analyses of urinary calprotectin level in the discrimination of high-grade from lower grade tumors and non-muscle-invasive from muscle-invasive tumors (area under the curve [AUC]=0.92, 95% confidence interval [CI], 0.671–0.913, p<0.0001; and AUC=0.85, 95% CI, 0.69–1.00, p=0.01; respectively).

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