Abstract
BackgroundConventional clinical detection methods such as CT, urine cytology, and ureteroscopy display low sensitivity and/or are invasive in the diagnosis of upper tract urinary carcinoma (UTUC), a factor precluding their use. Previous studies on urine biopsy have not shown satisfactory sensitivity and specificity in the application of both gene mutation or gene methylation panels. Therefore, these unfavorable factors call for an urgent need for a sensitive and non-invasive method for the diagnosis of UTUC.MethodsIn this study, a total of 161 hematuria patients were enrolled with (n = 69) or without (n = 92) UTUC. High-throughput sequencing of 17 genes and methylation analysis for ONECUT2 CpG sites were combined as a liquid biopsy test panel. Further, a logistic regression prediction model that contained several significant features was used to evaluate the risk of UTUC in these patients.ResultsIn total, 86 UTUC− and 64 UTUC+ case samples were enrolled for the analysis. A logistic regression analysis of significant features including age, the mutation status of TERT promoter, and ONECUT2 methylation level resulted in an optimal model with a sensitivity of 94.0%, a specificity of 93.1%, the positive predictive value of 92.2% and a negative predictive value of 94.7%. Notably, the area under the curve (AUC) was 0.957 in the training dataset while internal validation produced an AUC of 0.962. It is worth noting that during follow-up, a patient diagnosed with ureteral inflammation at the time of diagnosis exhibiting both positive mutation and methylation test results was diagnosed with ureteral carcinoma 17 months after his enrollment.ConclusionThis work utilized the epigenetic biomarker ONECUT2 for the first time in the detection of UTUC and discovered its superior performance. To improve its sensitivity, we combined the biomarker with high-throughput sequencing of 17 genes test. It was found that the selected logistic regression model diagnosed with ureteral cancer can evaluate upper tract urinary carcinoma risk of patients with hematuria and outperform other existing panels in providing clinical recommendations for the diagnosis of UTUC. Moreover, its high negative predictive value is conducive to rule to exclude patients without UTUC.
Highlights
Upper tract urinary carcinoma (UTUC) including renal pelvic cancer and ureteral cancer accounts for approximately 5% of urothelial carcinomas [1, 2]
TERT C228T, FGFR3 c.746C>G, c.1118A>G, and TERT C250T were on the top 4 of the list with a long tail of several other mutations from ERBB2, HRAS, KRAS, PIK3CA, TP53, U2AF1, and AKT1 (Supplementary Table 1). This distribution pattern of driver genes corroborates with previous research in the sense that TERT, FGFR3, TP53, PIK3CA, and RAS genes exhibited high frequencies in the UTUC mutation landscape
We evaluated the performance of ONECUT2 methylation detection in the UTUC diagnostic cohort for the first time, with mutations of 17 genes being combined into the test panel
Summary
Upper tract urinary carcinoma (UTUC) including renal pelvic cancer and ureteral cancer accounts for approximately 5% of urothelial carcinomas [1, 2]. Ureteroscopy is the only standard method applied to acquire the pathological status of the samples [3, 4]. This method, is an invasive procedure that can only be performed in the hospital by experienced doctors. Conventional clinical detection methods such as CT, urine cytology, and ureteroscopy display low sensitivity and/or are invasive in the diagnosis of upper tract urinary carcinoma (UTUC), a factor precluding their use. Previous studies on urine biopsy have not shown satisfactory sensitivity and specificity in the application of both gene mutation or gene methylation panels
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