Mp38-15 What Will It Take for a Urine Biomarker to Replace Surveillance Cystoscopy for Intravesical Recurrence (Ivr) After Radical Nephroureterectomy (Rnu)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-15 WHAT WILL IT TAKE FOR A URINE BIOMARKER TO REPLACE SURVEILLANCE CYSTOSCOPY FOR INTRAVESICAL RECURRENCE (IVR) AFTER RADICAL NEPHROURETERECTOMY (RNU) Zhuo T. Su, Royce Lee, Aurora Grutman, James Flynn, Joseph Cheaib, Stephan Brönimann, Sunil Patel, Max Kates, and Nirmish Singla Zhuo T. SuZhuo T. Su , Royce LeeRoyce Lee , Aurora GrutmanAurora Grutman , James FlynnJames Flynn , Joseph CheaibJoseph Cheaib , Stephan BrönimannStephan Brönimann , Sunil PatelSunil Patel , Max KatesMax Kates , and Nirmish SinglaNirmish Singla View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients who have undergone RNU for upper tract urothelial carcinoma (UTUC) are subject to frequent cystoscopic surveillance for IVR. We aimed to identify the required diagnostic accuracy of a potential urine biomarker to replace cystoscopy in post-RNU surveillance. METHODS: We created a Monte-Carlo simulation to model the performance of a urine biomarker for detecting IVR in a cohort of 10,000 patients for 5 years after they underwent RNU for high-grade (HG) UTUC. In the reference case, patients underwent surveillance with cystoscopy and cytology per schedule in the 2023 American Urological Association (AUA) guideline. In experimental cases, patients underwent cystoscopy with the urine biomarker 3 months after RNU. If negative, patients were then tested with the urine biomarker alone, instead of cystoscopy and cytology, at each surveillance point in the AUA schedule. A positive test would trigger cystoscopy in the operating room and transurethral resection or biopsy as needed. We varied the biomarker's sensitivity from 15% to 99%. RESULTS: In the reference case, 29.6% of the cohort developed IVR within 5 years after RNU. In experimental cases, as the sensitivity of the urine biomarker increased from 15% to 99%, the proportion of patients with IVR in the reference case who failed to be detected decreased from 22.9% to 1.5% (Figure 1). Figure 2 shows the proportion of patients with IVR in the reference case whose IVR diagnosis was delayed and the average delay to diagnosis in experimental cases. As the sensitivity reached 93%, among patients with IVR in the reference case, 1.8% failed to be detected, and in another 4.8% of these patients, IVR diagnosis was delayed by an average of 3.4 months compared to the reference case. These results were independent of the specificity of the biomarker. CONCLUSIONS: If a urine biomarker were to replace cystoscopy in surveillance after RNU for HG UTUC, its sensitivity needs to be ≥93% so that <2% of IVRs within 5 years would be missed and <5% of IVR diagnoses would be delayed, by <4 months on average. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e647 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zhuo T. Su More articles by this author Royce Lee More articles by this author Aurora Grutman More articles by this author James Flynn More articles by this author Joseph Cheaib More articles by this author Stephan Brönimann More articles by this author Sunil Patel More articles by this author Max Kates More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...