Urinary hyaluronic acid: a versatile marker of bladder cancer.

To evaluate the role of urinary hyaluronic acid (HA) as a diagnostic marker in urothelial carcinoma (UCC), squamous cell carcinoma (SCC), and adenocarcinoma (ADC) of urinary bladder and compare it with urine cytology.

HA was estimated in 170 subjects divided into three groups. Group I: UCC 88 patients, 28 with SCC and 12 with ADC; group II: 34 patients with benign bladder tumors; and group III: 10 healthy bladders. HA was estimated in urine and then readjusted to creatinine (HA/Cr) and protein (HA/Pr) in urine. Urine cytology was evaluated.

The mean ± SD level HA was higher in UCC (589 ± 72), SCC (637 ± 45), and ADC (526 ± 30) as compared with benign (476 ± 92) and normal (277 ± 44) groups regardless the grade of tumor (p < 0.0001). A cutoff value of 490 ng/ml was calculated to detect malignancy with sensitivity of 98% and specificity of 66%. PPV, NPV, and ACC were 88.6%, 94.1%, and 90%, respectively. Urine cytology showed sensitivity of, specificity, PPV, NPV, and ACC of 52.6%, 90%, 90.45, 50%, and 65.5%, respectively. HA/Pr and HA/Cr, cutoff values for detection of malignancy were 84.9 and 9.6 but with less predictive values. Histopathological type was the only independent factor affecting level of HA on multivariate analysis, (p = 0.012, Exp (B) 14.98, 95% CI 1.8-121).

Combination of urinary HA and urine cytology provides reliable marker of bladder cancer.

International urology and nephrology. 2020 May 01 [Epub ahead of print]

Ahmad Sobhy El-Hefnawy, Ehsan Mohamed Abd El Aty Rizk, Nabila Maher Al Demerdash Khamis, Mohammed Ali Atwa Barakat, Sherry M Khater, Ahmed A Shokeir

Department of Urology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt. ., Department of Clinical Pathology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt., Department of Histopathology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Department of Urology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.