gms | German Medical Science

Introduction: Neoadjuvant chemotherapy in combination with radical cystectomy is the standard of care for muscle-invasive bladder cancer. In general, 30–40% of the patient’s response totally of the neoadjuvant chemotherapy. Mxi-2 is the truncated variant of MAPK p38 and Vimentin3 (Vim3) is the truncated version of vimentin. Until now, there is no proper diagnostic tool, which allows the prediction of the therapy response after neoadjuvant chemotherapy.

Methods: 20 patients with muscle-invasive urothelial carcinoma of the urinary bladder and negative staging for systemic metastases underwent neoadjuvant systemic chemotherapy with 4 cycles of gemcitabine and cisplatin. Following 2 and 4 cycles restaging via CT chest, abdomen and pelvis was performed. All patients underwent radical cystectomy, extended pelvic lymphadenectomy and urinary diversion 3–5 weeks following chemotherapy. Patients with pT0pN0 were considered as complete remission whereas any persistent bladder cancer or lymph node metastases were considered as incomplete remission. For the determination of the prediction of the neoadjuvant chemotherapy urine from 10 healthy controls, 20 patients with complete remission and non-remission were tested for the expression of Mxi-2 and Vim3 in urine via ELISA.

Results: There was significant differences in the Mxi-2 expression between patients with a complete remission and no remission in urine after neoadjuvant chemotherapy. For Mxi-2 a sensitivity of 88% and a specificity of 92%. There was no significant difference in the Vim3 expression. The determination of Mxi-2 and Vim3 via ELISA is a quick and low coasts method.

Conclusions: The determination of the non-invasive marker Mxi-2 and Vim3 in patients prior to and following neoadjuvant chemotherapy allows the prediction of the response after neoadjuvant chemotherapy before cystectomy. For the future, we increase the number of patients and prospectively evaluate the predictive accuracy of both, urinary biomarkers and multiparametric MRI of the bladder for the detection of muscle-invasive bladder cancer.