Evaluation of The Diagnostic Power of New Urinary Molecular Biomarkers in The Early Diagnosis of Urinary Bladder Cancer

Abstract

Background: Urinary molecular biomarkers attracting interests as potential tools for early detection and prognosis of urinary bladder cancer (UBC). This study was performed to assess the diagnostic ability of Nuclear Matrix Protein 22 (NMP22), Bladder Tumor Antigen (BTA), microRNA-21 (miR-21) and survivin (BIRC5) in urinary bladder cancer patients.

Methods: A case–control study conducted at Al-Forat A-Awsat Oncology Center, Najaf, Iraq during July 2025 to February 2026. A total 110 subjects were included: 62 patients with histopathological confirm of urinary bladder malignancy, and 48 healthy controls. Standardized collection of fresh urine samples NMP22 and BTA were measured in urine using enzyme-linked immunosorbent assay (ELISA) kits. Methods qRT-PCR was used to measure the expression levels of miR-21 and survivin (BIRC5).

Results: The urinary levels of NMP22 (24.85 ± 8.37 U/mL vs. 9.42 ± 3.18 U/mL), BTA (42.71 ± 12.65 U/mL vs. 18.53 ± 6.27 U/mL), and miR-21 expression (3 Standardized DNA tests for the diagnosis of bladder carcinoma on urine) were significantly higher in patients compared with healthy controls (p <0 001). As a result, survivin had the highest diagnostic with an area under the operating curve (AUC) of 0.945 (sensitivity and specificity: 93.5% and 89.6%), and it was followed by miR-21 AUC = 0.927(91.9% sensitivity,87.5% specificity). AUC value was good for NMP22 (0.841) and BTA 0.812 also, which showed that these two diagnostic tests are doing important role in diagnosis of bladder cancer.

Conclusions: NMP22, BTA, miR-21 and survivin were differentially dysregulated in UCB patients and associated with disease progression. Both survivin and miR-21 displayed better diagnostic and prognostic ability in all biomarkers.

Keywords:

NMP22, BTA, miR-21, Survivin, Urinary bladder cancer

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