Abstract
BackgroundPrevious researches pointed out that the measurement of urine fibronectin (Fn) could be a potential diagnostic test for bladder cancer (BCa). We conducted this meta-analysis to fully assess the diagnostic value of urine Fn for BCa detection.MethodsA systematic literature search in PubMed, ISI Web of Science, EMBASE, Cochrane library, and CBM was carried out to identify eligible studies evaluating the urine Fn in diagnosing BCa. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) were calculated, and summary receiver operating characteristic (SROC) curves were established. We applied the STATA 13.0, Meta-Disc 1.4, and RevMan 5.3 software to the meta-analysis.ResultsEight separate studies with 744 bladder cancer patients were enrolled in this meta-analysis. The pooled sensitivity, specificity, and DOR were 0.80 (95%CI = 0.77–0.83), 0.79 (95%CI = 0.73–0.84), and 15.18 (95%CI = 10.07–22.87), respectively, and the area under the curve (AUC) of SROC was 0.83 (95%CI = 0.79–0.86). The diagnostic power of a combined method (urine Fn combined with urine cytology) was also evaluated, and its sensitivity and AUC were significantly higher (0.86 (95%CI = 0.82–0.90) and 0.89 (95%CI = 0.86–0.92), respectively). Meta-regression along with subgroup analysis based on various covariates revealed the potential sources of the heterogeneity and the detailed diagnostic value of each subgroup. Sensitivity analysis supported that the result was robust. No threshold effect and publication bias were found in this meta-analysis.ConclusionsUrine Fn may become a promising non-invasive biomarker for bladder cancer with a relatively satisfactory diagnostic power. And the combination of urine Fn with cytology could be an alternative option for detecting BCa in clinical practice. The potential value of urine Fn still needs to be validated in large, multi-center, and prospective studies.
Highlights
Previous researches pointed out that the measurement of urine fibronectin (Fn) could be a potential diagnostic test for bladder cancer (BCa)
In our meta-analysis, we included researches that met the following criteria: (1) studies utilized urine Fn as a diagnostic test for human bladder cancer patients, (2) the bladder tumor was confirmed by pathology, (3) the urine samples were collected before the final treatments, (5) studies reported the sensitivity (Sen) and specificity (Spe) of urine Fn with their 95% confidence intervals (CIs), gave the number of true positive (TP)/false positive (FP)/false negative(FN)/true negative(TN), or provided sufficient information to calculate them, (6) studies gave clear cut-off value or cut-off criteria
Five of them reported the diagnostic value of both urine Fn itself and urine Fn combined with urine cytology (Fn+Cyto) [18, 20, 22,23,24]
Summary
Previous researches pointed out that the measurement of urine fibronectin (Fn) could be a potential diagnostic test for bladder cancer (BCa). We conducted this meta-analysis to fully assess the diagnostic value of urine Fn for BCa detection. Cystoscopy is still the standard way for the detection and diagnosis of bladder cancer. This invasive examining method is costly and may lead to trauma and infection of the urinary system [5]. To get rid of this predicament, scientists have spent over 20 years looking for a sensitive, specific, and non-invasive biomarker for the detection of bladder cancer. U.S Food and Drug Administration has approved bladder tumor antigen (BTA), fibrin/fibrinogen degradation product (FDP), and nuclear matrix protein 22 (NMP 22) for clinically detecting patients with bladder cancer [9]
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