Due to insufficient accuracy, urine-based assays currently have a limited role in the management of patients with upper tract urothelial carcinoma (UTUC). The application of a robust urine-based multiplex assay, Oncuria-Detect®, to aid in the detection of UTUC has the potential to address this deficiency and to assist with accurate, non-invasive diagnosis.
Methods:
To evaluate the performance of Oncuria-Detect®, a multiplex immunoassay capable of querying a voided urine sample for 10 protein biomarkers associated with urothelial carcinoma (A1AT, APOE, ANG, CA9, IL8, MMP9, MMP10, PAI1, SDC1 and VEGFA). Its application to UTUC was evaluated in a multi-institutional cohort of 35 prospectively collected subjects presenting for evaluation of upper tract mass along with 46 prospective collected matched controls (i.e., non-tumor bearing). The ability of the test to identify patients harboring UTUC was assessed. UTCU status was confirmed by endoscopy and tissue biopsy or definitive surgery. Diagnostic performance was assessed using ROC curves.
Results:
Oncuria-Detect® provided an AUC of 0.886 (95% CI: 0.807-0.964) with an overall sensitivity of 91.4%, specificity of 73.9%, NPV 91.9% and PPV 72.7%. Sensitivity values of the diagnostic panel for low-grade UTUC, high-grade UTUC, non-invasive UTUC and invasive UTUC were 86.7%, 90.9%, 88.9% and 94.1%, respectively. Urinary cytology or selective ureteral washing/cytology was associated with an overall sensitivity of 54.2%, specificity of 100%, NPV 63.3% and PPV 100%. Sensitivity values of cytology for low-grade UTUC, high-grade UTUC, non-invasive UTUC and invasive UTUC were 100%, 100%, 100%, and 77.8%, respectively.
Conclusions:
Urinary levels of a biomarker panel enabled the accurate discrimination of UTUC and controls non-tumor bearing individuals. The multiplex Oncuria-Detect® test can achieve the efficient and accurate detection of UTUC in a non-invasive patient setting.
- Toru Sakatani, Cedars-Sinai Medical Center, Los Angeles, CA
- Sunao Tanaka, Cedars-Sinai Medical Center, Los Angeles, CA
- Kazutoshi Fujita, Kindai University, Osaka, Japan
- Jennifer Linehan, Saint John's Cancer Institute, Santa Monica, CA
- Kaoru Murakami, Cedars-Sinai Medical Center, Los Angeles, CA
- Riko Lee, University of Hawaii Cancer Center, Honolulu, HI
- Ian Pagano, University of Hawaii Cancer Center, Honolulu, HI
- Charles J. Rosser, Cedars-Sinai Medical Center, Los Angeles, CA
- Hideki Furuya, Cedars-Sinai Medical Center, Los Angeles, CA
Assessment of the Diagnostic Accuracy of Oncuria-Detect® for Detection of Upper Tract Urothelial Carcinoma