Molecular Signature of hTERT, FGFR, SPTAN 1 as a Non Invasive Biomarker of Bladder Cancer in Pre and Post Mitomycin Treated Patients

Background: Bladder cancer (BC) is one of the most prevalent malignancies of the urinary tract, characterized by high recurrence rates and limited reliable biomarkers for disease monitoring. This study aimed to identify and validate non-invasive molecular biomarkers—Human Telomerase Reverse Transcriptase (hTERT), Fibroblast Growth Factor Receptor (FGFR), and Non-erythroid Spectrin II (SPTAN1)—in non-muscle invasive bladder cancer (NMIBC) patients before and after Mitomycin therapy. Methods: A prospective cohort study was conducted on 100 participants aged ≥18 years, including 50 patients with histologically confirmed BC scheduled for Mitomycin treatment and 50 healthy controls. Expression levels of hTERT, FGFR, and SPTAN1 were quantified pre- and post-treatment using molecular assays, and their diagnostic and prognostic significance was assessed. Results: Baseline hTERT, FGFR, and SPTAN1 levels were significantly elevated in BC patients compared with controls and declined markedly following Mitomycin therapy. During follow-up, 32% of patients experienced recurrence. Pre-treatment hTERT and FGFR levels were significantly higher in the recurrence group, while SPTAN1 remained elevated both pre- and post-treatment. Diagnostic analysis demonstrated high accuracy for hTERT (AUC = 0.893; sensitivity = 82.35%; specificity = 87.5%) and FGFR (AUC = 0.842; specificity = 100%). SPTAN1 showed moderate correlations with tumor size, hTERT, and FGFR. Conclusions: hTERT, FGFR, and SPTAN1 serve as promising non-invasive biomarkers for assessing Mitomycin response and predicting recurrence in BC patients. Among them, SPTAN1 and hTERT exhibit the strongest prognostic potential, supporting their use in personalized management of bladder cancer.