Urine-Based Biomarker Test Uromonitor® in the Detection and Disease Monitoring of Non-Muscle-Invasive Bladder Cancer-A Systematic Review and Meta-Analysis of Diagnostic Test Performance

Anton P Kravchuk; Ingmar Wolff; Christian Gilfrich; Ralph M Wirtz; Paula Soares; Kay-Patrick Braun; Sabine D Brookman-May; Lisa Kollitsch; Katharina Hauner; Martin Burchardt; Johannes Bründl; Maximilian Burger; Matthias May

doi:10.3390/cancers16040753

Urine-Based Biomarker Test Uromonitor^® in the Detection and Disease Monitoring of Non-Muscle-Invasive Bladder Cancer-A Systematic Review and Meta-Analysis of Diagnostic Test Performance

Cancers (Basel). 2024 Feb 11;16(4):753. doi: 10.3390/cancers16040753.

Authors

Affiliations

¹ Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany.
² Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany.
³ STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany.
⁴ IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal.
⁵ Department of Pathology and Oncology, Faculty of Medicine, University of Porto, 4200-139 Porto, Portugal.
⁶ Institute of General Practice, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany.
⁷ Department of Urology, Ludwig-Maximilians-University, 81377 Munich, Germany.
⁸ Johnson and Johnson Innovative Medicine, Research & Development, Spring House, PA 19477, USA.
⁹ Department of Urology and Andrology, Klinik Donaustadt, A1220 Vienna, Austria.
¹⁰ Department of Urology, University Hospital MRI-TUM (München rechts der Isar), 81675 Munich, Germany.
¹¹ Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, 93053 Regensburg, Germany.

Abstract

Optimal urine-based diagnostic tests (UBDT) minimize unnecessary follow-up cystoscopies in patients with non-muscle-invasive bladder-cancer (NMIBC), while accurately detecting high-grade bladder-cancer without false-negative results. Such UBDTs have not been comprehensively described upon a broad, validated dataset, resulting in cautious guideline recommendations. Uromonitor^®, a urine-based DNA-assay detecting hotspot alterations in TERT, FGFR3, and KRAS, shows promising initial results. However, a systematic review merging all available data is lacking. Studies investigating the diagnostic performance of Uromonitor^® in NMIBC until November 2023 were identified in PubMed, Embase, Web-of-Science, Cochrane, Scopus, and medRxiv databases. Within aggregated analyses, test performance and area under the curve/AUC were calculated. This project fully implemented the PRISMA statement. Four qualifying studies comprised a total of 1190 urinary tests (bladder-cancer prevalence: 14.9%). Based on comprehensive analyses, sensitivity, specificity, positive-predictive value/PPV, negative-predictive value/NPV, and test accuracy of Uromonitor^® were 80.2%, 96.9%, 82.1%, 96.6%, and 94.5%, respectively, with an AUC of 0.886 (95%-CI: 0.851-0.921). In a meta-analysis of two studies comparing test performance with urinary cytology, Uromonitor^® significantly outperformed urinary cytology in sensitivity, PPV, and test accuracy, while no significant differences were observed for specificity and NPV. This systematic review supports the use of Uromonitor^® considering its favorable diagnostic performance. In a cohort of 1000 patients with a bladder-cancer prevalence of ~15%, this UBDT would avert 825 unnecessary cystoscopies (true-negatives) while missing 30 bladder-cancer cases (false-negatives). Due to currently limited aggregated data from only four studies with heterogeneous quality, confirmatory studies are needed.

Keywords: FGFR3; KRAS; TERT; bladder cancer; detection; surveillance; test accuracy; urinary cytology; urine-based diagnostic tests.

Publication types

Review

Grants and funding

This research received no external funding.