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Review
. 2020 Dec 29;11(1):17.
doi: 10.3390/metabo11010017.

Urinary Volatile Organic Compound Analysis for the Diagnosis of Cancer: A Systematic Literature Review and Quality Assessment

Qing Wen  1 , Piers Boshier  1 , Antonis Myridakis  1 , Ilaria Belluomo  1 , George B Hanna  1
Affiliations
Review

Urinary Volatile Organic Compound Analysis for the Diagnosis of Cancer: A Systematic Literature Review and Quality Assessment

Qing Wen et al. Metabolites. .

Abstract

The analysis of urinary volatile organic compounds (VOCs) is a promising field of research with the potential to discover new biomarkers for cancer early detection. This systematic review aims to summarise the published literature concerning cancer-associated urinary VOCs. A systematic online literature search was conducted to identify studies reporting urinary VOC biomarkers of cancers in accordance with the recommendations of the Cochrane Library and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Thirteen studies comprising 1266 participants in total were included in the review. Studies reported urinary VOC profiles of five cancer subtypes: prostate cancer, gastrointestinal cancer, leukaemia/lymphoma, lung cancer, and bladder cancer. Forty-eight urinary VOCs belonging to eleven chemical classes were identified with high diagnostic performance. VOC profiles were distinctive for each cancer type with limited cross-over. The metabolic analysis suggested distinctive phenotypes for prostate and gastrointestinal cancers. The heterogenicity of study design, methodological and reporting quality may have contributed to inconsistencies between studies. Urinary VOC analysis has shown promising performance for non-invasive diagnosis of cancer. However, limitations in study design have resulted in inconsistencies between studies. These limitations are summarised and discussed in order to support future studies.

Keywords: cancer early detection; mass spectrometry; urine; volatile organic compounds.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. VOC: volatile organic compound. The systematic literature search identified 886 studies, with 13 studies included after screening and assessment for eligibility.
Figure 2
Figure 2
Number of identified volatile organic compounds (VOCs) in different cancers. For prostate cancer, 29 urinary VOCs from nine chemical classes were identified, and the majority of them were aromatic compounds, ketones, and organic acids. For gastrointestinal cancer, 21 VOCs from eight chemical classes were identified, 19 of which were not identified in prostate cancer urine. The majority were aromatic compounds, alcohols, and ketones.
Figure 3
Figure 3
Proportion of identified compound chemical classes in different cancers. Most prostate cancer-related VOCs showed decreased concentrations in the urine of prostate cancer patients compared to the urine of non-cancer patients. The majority of the gastrointestinal cancer-related VOCs showed increased concentrations, particularly of aromatic VOCs.
Figure 4
Figure 4
Metabolic pathways involved in cancers. (a) All metabolic pathways (b) Carbohydrate metabolism (c) Lipid metabolism (d) Amino acid metabolism (e) Energy metabolism. NOTE: P Ca: prostate cancer; GI Ca: gastrointestinal cancer. Gastrointestinal cancer had a greater association with carbohydrate metabolism and energy metabolism compared to prostate cancer, suggesting different underlying metabolic profiles of these cancers.
See this image and copyright information in PMC

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