SAN DIEGO, CA USA (UroToday.com) - Casey Seideman and colleagues reported on a multicenter study looking at the role of Urovysion FISH assay in surveillance of patients with bladder cancer and its role to predict recurrence in these patients.
They included patients with no cystoscopic evidence of tumor for analysis. Pathology, follow-up cystoscopy, cytology, and FISH data were analyzed. Their primary endpoint was cancer recurrence, defined by biopsy.
A total of 523 patients were included for analysis. Of these 427 were male (82%) and mean age was 68.7. Mean follow-up was 28.2 months. 35.6% recurred, at a mean time of 15.8 months. FISH had a positive predictive value (PPV) of 53.8%, negative predictive value (NPV) of 74.9%, sensitivity of 60.4%, and specificity of 70%. 149 patients had atypical cytology with a positive FISH. There were 84 recurrences in this subgroup. If FISH was positive and cytology was atypical, the PPV, NPV, sensitivity, and specificity were 56.4%, 72.7%, 45%, and 81%, respectively. Mean time to recurrence in this subgroup was 12.6 months, vs 20.7 months for patients who were FISH negative, with normal cytology. Univariate analysis identified atypical cytology and positive FISH to be associated with recurrence (p < 0.05). No association was found between stage, grade, intravesical therapy and likelihood of recurrence. On multivariate analysis, only cytology was associated with recurrence (p=0.008).
The authors concluded that in the absence of visible tumor, and in a setting of positive FISH and atypical cytology, these patients should be followed closely because they are more likely to recur. Randomized prospective study should be able to validate these findings.
Presented by Casey Seideman, Daniel Canter, Phillip Kim, Billy Cordon, Alon Weizer, Irma Oliva, Jianyu Rao, Brant Inman, Michael Posch, Margaret Lakowske, Harry Herr, and Yair Lotan at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD
