Urinary Cytokeratin 20 as a Marker for Transitional Cell CarcinomaRotem D.a · Cassel A.a · Lindenfeld N.a · Mecz Y.b · Sova Y.c · Resnick M.c · Stein A.b
aHematology Laboratory and Departments of bUrology and cPathology, Carmel Medical Center, Haifa, Israel
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Objectives: To determine if detection of cytokeratin 20 (CK20) gene expression, by reverse transcriptase–polymerase chain reaction (RT–PCR) in urine from transitional cell carcinoma (TCC) patients, can provide a new noninvasive tool for the follow–up of patients with urothelial carcinoma of the bladder.
Methods: Urine was collected from 95 patients previously diagnosed as TCC during their follow–up, and from 27 healthy volunteers. All patients had a transurethal resection of tumor or biopsies obtained from ‘suspicious’ areas in the bladder. RNA was extracted from cells collected from the urine and RT–PCR was performed with specific primers for the amplification of cytokeratin 8, a general marker for epithelial cells, and of CK 20, a marker for TCC urothelium.
Results: CK20 expression was detected in 86.7% of TCC patients, and only in 3.3% of healthy volunteers (specificity 96.7%). Strong correlation was found between tumor grade and expression of CK20 in urine. All grade III and IV tumors demonstrated positive CK20 expression (100% sensitivity), whereas the sensitivity for lower grades was between 71 and 80%. Among 11 patients with a previous biopsy–proven diagnosis of TCC and a current negative biopsy, in 9 patients CK20 expression was detected. Further follow–up of these patients for a period of 6 months revealed recurrence of TCC in 4 patients.
Conclusion: CK20 detection in urine cells is a simple, noninvasive method with a high potential to become the marker of choice for monitoring and follow–up of TCC patients. More information is needed regarding CK20 expression in nonmalignant urological disease, to evaluate its use for routine screening purposes.
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