尿路上皮癌の診断における尿中NMP22(Nuclear Matrix Protein 22)の有用性に関する検討

Abstract

血尿の程度が強いと有用でなかった.ROC曲線により求めたcut off値は9.2u/mlとなった.この時感受性は血尿症例で91.7%, 尿路上皮癌経過観察中の症例で81.8%であった.本邦で推奨されているcut off値12.0u/mlを用いると感受性は低下し, pT2以上の膀胱癌で感受性75.0%であった.NMP22は尿路上皮癌の診断に有用であるが, 本邦で推奨されているcut off値はやや高い可能性がある

We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.