BACKGROUND: Several studies have demonstrated that abnormal levels of nuclear matrix protein 22 (NMP22) are associated with bladder cancer and have led to the approval of NMP22 as a urinary biomarker by the US Food and Drug Administration. Nonetheless, the clinical significance of NMP22 remains unclear. The objective of this study was to use decision analysis to determine whether NMP22 improves medical decision-making. METHODS: The current study included 2222 patients who had a history of nonmuscle-invasive bladder cancer and current negative cytology. The authors developed models to predict cancer recurrence or progression to muscle-invasive disease using voided NMP22 levels, cystoscopy, age, and sex. Clinical net benefit was calculated by summing the benefits (true-positives), subtracting the harms (false-positives), and weighting these values by the threshold probability at which a patient or clinician would opt for cytoscopy. RESULTS: After cystoscopy, 581 patients (26%) had cancer identified. The NMP22 level was associated significantly with bladder cancer recurrence and progression (P < .001 for both). The use of NMP22 in a model with age and sex was associated with better patient outcomes than performing cystoscopy on everyone and produced threshold probabilities > 8% for recurrence and > 3% for progression. Only offering cystoscopy to those who had a risk > 15% reduced the number of cystoscopies by 229 while missing only 25 cancer recurrences per 1000 men with negative cytology. The current study was limited by its multicenter design. CONCLUSIONS: For clinicians who would perform a cystoscopy at a threshold of 5% for recurrence or 1% for progression, NMP22 did not aid clinical decision-making. For less risk-averse clinicians who would only perform a cystoscopy at a threshold probability >thinsp;8% for recurrence or > 3% for progression, NMP22 helped to indicate which patients required cystoscopy and which could be spared this procedure.
BACKGROUND: Several studies have demonstrated that abnormal levels of nuclear matrix protein 22 (NMP22) are associated with bladder cancer and have led to the approval of NMP22 as a urinary biomarker by the US Food and Drug Administration. Nonetheless, the clinical significance of NMP22 remains unclear. The objective of this study was to use decision analysis to determine whether NMP22 improves medical decision-making. METHODS: The current study included 2222 patients who had a history of nonmuscle-invasive bladder cancer and current negative cytology. The authors developed models to predict cancer recurrence or progression to muscle-invasive disease using voided NMP22 levels, cystoscopy, age, and sex. Clinical net benefit was calculated by summing the benefits (true-positives), subtracting the harms (false-positives), and weighting these values by the threshold probability at which a patient or clinician would opt for cytoscopy. RESULTS: After cystoscopy, 581 patients (26%) had cancer identified. The NMP22 level was associated significantly with bladder cancer recurrence and progression (P < .001 for both). The use of NMP22 in a model with age and sex was associated with better patient outcomes than performing cystoscopy on everyone and produced threshold probabilities > 8% for recurrence and > 3% for progression. Only offering cystoscopy to those who had a risk > 15% reduced the number of cystoscopies by 229 while missing only 25 cancer recurrences per 1000 men with negative cytology. The current study was limited by its multicenter design. CONCLUSIONS: For clinicians who would perform a cystoscopy at a threshold of 5% for recurrence or 1% for progression, NMP22 did not aid clinical decision-making. For less risk-averse clinicians who would only perform a cystoscopy at a threshold probability >thinsp;8% for recurrence or > 3% for progression, NMP22 helped to indicate which patients required cystoscopy and which could be spared this procedure.
Authors: Shahrokh F Shariat; Michael J Marberger; Yair Lotan; Marta Sanchez-Carbayo; Craig Zippe; Gerson Lüdecke; Hans Boman; Ihor Sawczuk; Martin G Friedrich; Roberto Casella; Christine Mian; Sanaa Eissa; Hideyuki Akaza; Vincenzo Serretta; Hartwig Huland; Hans Hedelin; Rupesh Raina; Naoto Miyanaga; Arthur I Sagalowsky; Claus G Roehrborn; Pierre I Karakiewicz Journal: J Urol Date: 2006-09 Impact factor: 7.450
Authors: Shahrokh F Shariat; Craig Zippe; Gerson Lüdecke; Hans Boman; Marta Sanchez-Carbayo; Roberto Casella; Christine Mian; Martin G Friedrich; Sanaa Eissa; Hideyuki Akaza; Ihor Sawczuk; Vincenzo Serretta; Hartwig Huland; Hans Hedelin; Raina Rupesh; Naoto Miyanaga; Arthur I Sagalowsky; Frank Wians; Claus G Roehrborn; Yair Lotan; Paul Perrotte; Serge Benayoun; Michael J Marberger; Pierre I Karakiewicz Journal: J Urol Date: 2005-05 Impact factor: 7.450
Authors: N Miyanaga; H Akaza; S Ishikawa; M Ohtani; R Noguchi; K Kawai; K Koiso; M Kobayashi; A Koyama; T Takahashi Journal: Eur Urol Date: 1997 Impact factor: 20.096
Authors: D S Stampfer; G A Carpinito; J Rodriguez-Villanueva; L W Willsey; C P Dinney; H B Grossman; H A Fritsche; W S McDougal Journal: J Urol Date: 1998-02 Impact factor: 7.450
Authors: Yair Lotan; Umberto Capitanio; Shahrokh F Shariat; Georg C Hutterer; Pierre I Karakiewicz Journal: BJU Int Date: 2009-03-11 Impact factor: 5.588
Authors: Shahrokh F Shariat; Roberto Casella; Frank H Wians; Raheela Ashfaq; Jody Balko; Tullio Sulser; Thomas C Gasser; Arthur I Sagalowsky Journal: Eur Urol Date: 2004-03 Impact factor: 20.096
Authors: Georg C Hutterer; Pierre I Karakiewicz; Craig Zippe; Gerson Lüdecke; Hans Boman; Marta Sanchez-Carbayo; Roberto Casella; Christine Mian; Martin G Friedrich; Sanaa Eissa; Hideyuki Akaza; Vincenzo Serretta; Hans Hedelin; Raina Rupesh; Naoto Miyanaga; Arthur I Sagalowsky; Paul Perrotte; Yair Lotan; Michael J Marberger; Shahrokh F Shariat Journal: BJU Int Date: 2008-03 Impact factor: 5.588
Authors: Michael D Bell; Faysal A Yafi; Fadi Brimo; Jordan Steinberg; Armen G Aprikian; Simon Tanguay; Wassim Kassouf Journal: World J Urol Date: 2016-02-23 Impact factor: 4.226