Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 1 REVIEW histopathological tests. Invasive tests include cystoscopy and fluorescence cystoscopy which remain the gold stan- dard for detecting bladder cancer. Non-invasive tests include urine cytology (a standard test with high specifici- ty but low sensitivity especially for low-grade cancers) (1- 3). Urine-based tests are the most common non-invasive methods for detecting bladder cancer, including protein, transcriptomic, and epigenetic markers. Multiple studies have assessed cell-free DNA, DNA mutation, methylated DNA, circulating tumour cells, miRNA, mRNAs, cell-free proteins and peptides in urine specimens and blood (4). Circulating urinary tumour DNA (utDNA) has shown a major sensitivity over traditional urine cytology and offers genomic and epigenetic insights (5). Four urinary bio- markers have FDA approval, but they have not replaced cystoscopy and cytology due to limitations in sensitivity and specificity (6). Several studies have identified several proteins in urinary extracellular vehicles (EVs) that show potential, such as MASP2, C3, A2M, CHMP2A, and NHE- RF1 (7). Advances in next-generation sequencing have highlighted genomic, transcriptomic, and epigenetic markers as promising candidates (8). Furthermore, in the current lit- erature, multitarget biomarker panels offer better diag- nostic accuracy compared with single biomarkers (9, 10). Research has focused on identifying new biomarkers capable of reducing the use of invasive diagnostic meth- ods or to be complements of traditional methods (1-3), however, their clinical utility is still under investigation due to varying sensitivity and specificity. For this reason, the aim of our work is, through a biblio- metric analysis of the literature, to evaluate the typology, methods, diffusion, and evolution of published papers to orient towards more aware research of the available mate- rial. Currently, bibliometric analysis has turned into an accepted method to present the research patterns of scien- tific literature (11). It provides evidence regarding the progress of a specific domain, accentuating the most rele- vant country, journals, authors, and institutes involved in Background/Objectives: Bladder cancer is a multifactorial disease, ranking as the 10th most common cancer globally and the fourth most common cancer in men and the ninth in women in the Western world. This bibliometric analysis aims to identify and evaluate scientific literature addressing new biomarkers for bladder cancer diagnosis, as well as to identify the most prolific organizations, authors, journals, countries, and keywords within this research domain. Methods: An electronic search was conducted using Elsevier's Scopus database. From a total of 940 retrieved papers (pub- lished between 2019 and 2024), 493 were selected. For data analysis and visualization, the titles of articles, year of publica- tion, countries, authors, journals, articles, and keywords were analyzed using Microsoft Excel, VOSviewer, and Biblioshiny. Results: China published the most papers (200 articles) and received the highest number of citations, followed by the USA. While some countries, such as Egypt and India, published exclusively Single Country Publications (SCPs), others demon- strated a higher level of international collaboration, with at least half of their publications being Multi-Country Publications (MCPs). Countries with higher rates of MCPs were Greece (66.6%), Italy (53.8%), Korea, and France (50%). The journals that produced the most publications and received the highest number of citations were Cancers, International Journal of Molecular Sciences, and Frontiers in Oncology, confirming their role in producing high-impact research. Conclusions: The consistent distribution of publications over the years considered indicates a sustained interest in this field. KEY WORDS: Bladder cancer; Biomarkers; Diagnosis; Screening; Bibliometric analysis. Submitted 17 November 2024; Accepted 13 December 2024 INTRODUCTION Bladder cancer (BC) diagnosis has traditionally relied upon different diagnostic tests, both invasive and non-invasive, including imaging-based, molecular, urine-based, and New biomarkers for diagnosis of bladder cancer: A bibliometric analysis Roberto Falabella 1, Valentina De Simone 2, Felice Crocetto 3, Francesco del Giudice 4, Angelo Porreca 5, Nazario Foschi 6, Biagio Barone 7, Luca Di Gianfrancesco 5, 6, Valentina Di Pasquale 2, Vincenzo Francesco Caputo 1 1 Unit of Urology, San Carlo Hospital, Potenza, Italy; 2 Department of Industrial Engineering, University of Salerno, Italy; 3 Unit of Urology, Department of Neurosciences, Reproductive science and Odontostomatology, University of Naples Federico II, Naples, Italy; 4 Department of Maternal infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto 1 Hospital, Rome, Italy; 5 Oncological Urology, Veneto Institute of Oncology (IOV), IRCCS, Padua, Italy; 6 Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 7 Department of Urology, P.O. San Paolo, Asl Na1 Centro, Naples, Italy. DOI: 10.4081/aiua.2025.13396 Summary Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 2 the research area (12, 13). During these years, the results of bibliometric analyses were used in orthopaedics, gynae- cology, and other medical fields (14-17), providing a guide for further research on disease prevention and treat- ment (18, 19). However, there is a paucity of bibliometric studies examining biomarkers in bladder cancer. Therefore, this study systematically analyzed the research of biomarkers in BC, to assess frontiers and hotspots in this field. In summary, the aim of this study was to ana- lyze global developments in biomarker studies, providing a valid analysis that projects the researcher towards new directions such as personalized medicine, liquid biopsy or the use of combinations of markers to improve diagnostic accuracy, sensitivity and specificity of tests and personal- ized treatment of the patient. MATERIALS AND METHODS The overall methodology followed to perform the biblio- metric analysis has been reported in Figure 1. Data collection The Scopus database, one of the largest peer-reviewed databases of multidisciplinary research publications, was used to search for the relevant literature related to the research topic of this study. The search was conducted in August 2024 and the search string was developed using terms in line with the aim of this research study. Search terms associated with (1) bladder cancer, (2) biomarkers, and (3) diagnosis have been combined using Boolean Operators (“OR”, “AND”). The overall string developed is reported below. TITLE-ABS-KEY( ["bladder cancer" OR "bladder carcino- ma") AND (biomarkers OR markers) AND (diagnosis)]. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), i.e., a technique that provides a roadmap to study systematic reviews objectively, clearly, and transparently, has been adopted in this research study for the establishment of an eligible set of articles to analyze (20). All articles related to the use of biomarkers for diag- nosis of bladder cancer have been considered relevant if they met the following criteria: (1) written in the English language, (2) focused on bladder cancer (3) involving bio- markers for diagnosis and not follow up of bladder cancer. The authors decided to include only research articles from peer-reviewed journals. This choice was mainly related to the quality of publications. The timespan was limited to the last six years (2019-2024). The period has been chosen to provide a detailed analysis of the topic focusing on the most recent publications trying to highlight how the research topic is changing. Two authors conducted the screening process following the PRISMA method as reported in Figure 2 following the inclusion criteria just discussed. In the analysis of the searched works, the following were exclud- ed from the analysis: Articles not relevant to bladder cancer (233 articles), articles related to gallbladder pathologies (43 articles), case reports (23 articles), articles dedicated to the analysis of new biomarkers only for the follow up of blad- der cancer (148 articles). Finally, data from the selected articles were gathered and stored in **.csv formats. Analysis After having defined the final set of articles, the biblio- metric analysis was carried out using Microsoft Excel and two bibliometric tools Biblioshiny and VOSviewer. Biblioshiny is an R statistical programming language tool developed by Aria and Cuccurullo (2017) (21) and designed for quantitative evaluation. The user-friendly interface of Biblioshiny makes it simple for users to import, modify, and generate interactive visualizations of data. Also, VosViewer, freely available software devel- oped for constructing and viewing bibliometric maps with significant attention to graphical representation, was employed for some of the analyses carried out. Figure 1. Research methodology. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 3 New biomarkers for diagnosis of bladder cancer As reported in Figure 1, a descriptive and performance analysis was defined. This analysis, focused on the publications and their main characteristics, aimed to examine the contribution of researchers in a given field (22). The most relevant authors, sources, affiliations, articles, etc. have been identified objectively. Subsequently, a more detailed analysis in the field of science mapping was performed. Focusing on key- words as a unit of analysis, the existing and possible future relationships between the topics were investigated. Keywords and their trends revealed the main themes on which researchers have focused over the years and that dominate the research landscape. RESULTS Figure 3 shows the annual change of studies from 2019 to 2024. The number of papers remains stable overall, highlighting a constant attention to the topic. The 493 publications identified are distributed across 253 different sources. Figure 4 exhibits the top 10 journals that contributed to the domain of bladder cancer biomarkers and in Figure 5 the citations received are reported. Cancers, International Journal of Molecular Sciences and Frontiers in Oncology pub- lished the highest number of articles (17 in the first 2 and 15 in the third), that received a high number of citations (respectively 213, 122 and 174). Urologic Oncology: Figure 2. PRISMA flow chart for the screening process. 493 included articles from a starting value of 4270 papers. Figure 3. Distribution of the number of papers per year. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 4 Seminars and Original Investigations is the first journal in the purely urological sector for the number of papers pub- lished, that is 13 with 147 citations. With 104 total publi- cations, the top 10 journals published 21% of all publica- tions identified in the last 5 years. Figure 6, instead, shows the evolution over time of publications on leading sources. Figure 4. Journals number of publications over the last 5 years. Figure 6. Distribution of Sources over the last 5 years. Figure 5. Journals number of citations over the last five years. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 5 New biomarkers for diagnosis of bladder cancer Performance of countries/regions on global output Table 1 and Figure 7 show the leading countries (the first 15) that published the highest number of papers related to bladder cancer biomarkers based on the nationality of the corresponding author. All articles were analyzed also con- sidering the difference between SCP (Single country publi- cation) and MCP (multi country publication) to indicate in addition to the corresponding authors also the other authors belong to the identified country. China published the highest number of papers (200) which represents 40.6% of all the articles identified, followed by the USA which published 41 articles (8.3% of the sample), although this primacy goes to Greece, followed by Poland, Korea, and Italy considering the ratio between the articles published and the population (expressed in millions of inhabitants) of the countries considered. Some countries, such as Egypt and India, published exclusively SCP-type articles. The countries with at least half of MCP articles and therefore greater collaboration at an international level are Greece (66.6%), Italy (53.8%), Korea (50%), and France (50%). With respect to collab- orations between authors from different countries, Figure 8 highlights the collaboration network identified in the selected papers. The different colors highlight the main clusters of co-authorship collaborations identified. It is clear that there are countries that have numerous collab- Table 1. Number of country publications and distribution of SCP and MCP articles in percentage. Country Articles* % Articles on the total sample SCP %SCP MCP %MCP Article/Population** CHINA 200 40.6% 178 89% 22 11% 0.14 USA 41 8.3% 31 75.6% 10 24.4% 0.12 EGYPT 22 4.5% 22 100% 0 0% 0.20 JAPAN 22 4.5% 20 90.9% 2 9.1% 0.18 GERMANY 16 3.2% 13 81.2% 3 18.8% 0.19 INDIA 14 2.8% 14 100% 0 0 0.01 IRAN 14 2.8% 11 78.6% 3 21.4% 0.16 UNITED KINGDOM 14 2.8% 8 57.1% 6 42.9% 0.20 ITALY 13 2.6% 6 46.2% 7 53.8% 0.22 KOREA 12 2.4% 6 50% 6 50% 0.23 POLAND 12 2.4% 10 83.3% 2 16.7% 0.33 TURKEY 11 2.2% 10 90.9% 1 9.1% 0.13 SPAIN 9 1.8% 8 88.9% 1 11.1% 0.19 FRANCE 8 1.6% 4 50% 4 50% 0.12 GREECE 6 1.2% 2 33.3% 4 66.7% 0.58 * Number of articles based on the corresponding authors. ** Population in millions of inhabitants. Figure 7. Journals number of citations over the last five years. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 6 orations (China, USA, Italy, Germany, Japan) and others with very limited collaborations (Egypt only with Jordan; India only with China; Iraq only with Iran; Taiwan only with Canada). The Country Scientific Production (Figure 9 and Table 2) was also calculated by measuring the total number of Authors by country affiliation. The number was obtained by considering the number of Corresponding Authors plus the number of co-authors of the same nationality who authored each paper. As a result, the sum of values of Scientific Production of all the countries is higher than the total number of papers considered (each paper contributing with more authors apart from papers with a single authorship). The results obtained numerically for the first 20 countries are reported in Table 2, where the overall production and total number of citations were also related to the popula- tion of the countries (millions of inhabitants in the year 2023). China and the USA are the top countries with respectively 1660 and 430 authors identified, however, Figure 9. Country scientific Production. The highest saturation for the major number of publications. Figure 8. Clusters of international collaborations. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 7 New biomarkers for diagnosis of bladder cancer Table 2. Results of top ten countries based on the country scientific production. # Country Overall Total Citations/ Country scientific production citations overall production/ production population * 1 CHINA 1660 2278 1.37 1.18 2 USA 430 612 1.42 1.28 3 JAPAN 263 347 1.32 2.11 4 UNITED KINGDOM 203 193 0.95 2.97 5 GERMANY 187 219 1.17 2.21 6 ITALY 171 135 0.79 2.91 7 EGYPT 120 201 1.68 1.06 8 TURKEY 107 39 0.36 1.25 9 FRANCE 101 594 5.88 1.48 10 KOREA 101 102 1.01 1.95 11 SPAIN 86 80 0.93 1.78 12 INDIA 84 40 0.48 0.06 13 IRAN 77 198 2.57 0.86 14 POLAND 71 90 1.27 1.94 15 NETHERLANDS 54 185 3.43 3.02 16 CANADA 47 39 0.83 1.17 17 GREECE 45 40 0.89 4.34 18 TUNISIA 43 8 0.19 3.45 19 DENMARK 41 9 0.22 6.89 20 ROMANIA 39 58 1.49 2.05 * Population in millions of inhabitants. Figure 10. Countries scientific production over time. considering the Country Scientific production per million inhabitants, Denmark, Greece, Tunisia, Netherlands, UK, and Italy are the countries with the highest scientific pro- duction. Figure 10 shows the trend of publications over time, show- ing strong growth for China and much slower growth for the remaining countries. Focusing, instead, on the citations received by the differ- ent countries (Figure 11 and Table 2), a different trend is noted. China, the USA and Japan maintain the first posi- tions, followed by countries such as France, or Iran which obtained a high number of citations despite a lower pro- duction. This aspect could depend on numerous factors: a greater or lesser quality of the published papers, different possibilities of access to the papers (open access or sub- scription), or a different temporal distribution of the works with relative impact on the recorded citations. Table 3 analyses the results of the different countries compared to European and non-European countries. Although with a lower overall number, 94 corresponding authors and 921 Country scientific production for EU- countries and 380 and 3300 for the others, the works published at the European level show a higher ratio between the citations received and the works published (respectively 1.69 versus 1.31). Furthermore, as also highlighted in Table 2 considering Table 3. Results of the EU- countries and no EU-countries. Articles Country scientific Citation Average Citations/country Average production articles/population* scientific production country scientific production/population* EU-countries 94 921 1554 0.29 1.69 2.19 No EU-countries 380 3300 4321 0.17 1.31 1.33 * Population in millions of inhabitants. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 8 the overall population of the countries considered, at the European level the number of publications and citations received per million inhabitants is higher. Affiliations performance analysis Going into the details of the authors’ affiliations, 1011 affiliations were identified for the 493 papers. Figure 12. Most relevant affiliations. Figure 11. Country Distribution of the number of citations. Table 4. Affiliations’ publications over time - Details. Figure 12 displays findings of the most relevant insti- tutes, based on the corresponding authors, that are pub- lished the most within the field. Peking University Shenzhein Hospital published 71 papers, followed by Zhongnan Hospital of Wuhan University and Shangai Jiao Tong University School of Medicine with 38 and 37 papers respectively. These main institutes also show (Figure 13) an increase in publications in the last 5 years. Extending the evalua- tion to all the authors of the papers, the first five institutes are reported in Table 4, with evidence also of the increase over time. Affiliation Country 2019 2020 2021 2022 2023 2024 Tot Peking University Shenzhen Hospital China 0 8 10 31 2 20 71 Zhongnan Hospital of Wuhan University China 8 9 9 0 0 12 38 Shanghai Jiao Tong University School of Medicine China 5 2 0 20 10 0 37 International Agency for Research on Cancer (Iarc) France 0 26 0 5 0 0 31 Central South University China 9 0 4 8 9 0 30 Osaka University Graduate School of Medicine Japan 0 16 0 14 0 0 30 Total 22 61 23 78 21 32 * Population in millions of inhabitants. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 9 New biomarkers for diagnosis of bladder cancer Authors performance analysis For 493 papers, a total of 3373 different authors were iden- tified with an average of 9.42 authors per paper. Only 3 articles are published by a single author. Furthermore, the international co-authorship is equal to 20.08%. Table 5 identifies the leading authors who published papers related to bladder cancer biomarkers in the last 5 years. Li X. published 21 papers, followed by Wang L, Wang X. Wang, Y and Zhang Y, who published 17 articles each. Li X. was the highest cited author (345), followed by Wang C Figure 13. Affiliations’ production over time. Figure 14. Most relevant authors based on the number of. document over times. and Wang Y, who received 336 and 333 citations, respec- tively (Table 5, Figure 14). The co-occurrence of authors is shown in Figure 15. Documents performance analysis Table 6 displays the highly cited papers on bladder cancer biomarkers. Among these, a paper Alix-Panabieres C. et al. published in 2021, received the highest citation (457). The subsequent most highly cited articles were by Usuba W et al.'s paper, which was published in 2019 and received 174 citations (Table 6). Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 10 Keywords performance analysis In the present analysis, various keywords were used in the domain of bladder cancer diagnostic biomarkers. Keyword performance analysis was carried out excluding the keywords used for primary research for example blad- der cancers, biomarker, and all similar. The keywords related to the methods applied in the papers identified (for example review, meta-analysis) were excluded. In this way, the top relevant keywords found in this analysis, according to the level of occurrence, were urine (34 papers), liquid biopsy (18 papers), urothelial carcinoma (16 papers), DNA methylation (13 papers) and miRNA (13 papers) (Figure 16). Considering the frequen- cy over the years considered, there is a growing use of the world urine, liquid biopsy, methylation, and miRna that confirm the interest in mini-invasive research of novel biomarkers for the diagnosis of BC (Figure 17). Figure 15. Co-authorship distribution. Figure 16. Most relevant keywords. Table 5. Most leading authors (number of papers and citations). Author Number of documents Total citations Li X. 21 345 Wang L. 17 261 Wang X. 17 139 Wang Y. 17 333 Zhang Y. 17 278 Li Y. 15 249 Wang Z. 15 164 Li J. 14 294 Wang J. 14 206 Wang H. 13 262 Zhang C. 13 91 Zhang J. 13 257 Li H. 12 124 Liu X. 12 141 Zhang X. 12 259 Zhao Y. 12 229 Chen J. 11 311 Chen X. 11 295 Liu S. 11 167 Liu Y. 11 90 Yang Y. 11 221 Chen Y. 10 67 Wang C. 10 336 Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 11 New biomarkers for diagnosis of bladder cancer Table 6. The top ten most cited papers. Authors Alix-Panabières C., Pantel K. Usuba W., Urabe F., Yamamoto Y., Matsuzaki J., Sasaki H., Ichikawa M., Takizawa S., Aoki Y., Niida S., Kato K., Egawa S., Chikaraishi T., Fujimoto H., Ochiya T. Chen X., Zhang J., Ruan W., Huang M., Wang C., Wang H., Jiang Z., Wang S., Liu Z., Liu C., Tan W., Yang J., Chen J., Chen Z., Li X., Zhang X., Xu P., Chen L., Xie R., Zhou Q., Xu S., Irwin D.L., Fan J.-B., Huang J., Lin T. Zhang S., Du L., Wang L., Jiang X., Zhan Y., Li J., Yan K., Duan W., Zhao Y., Wang L., Wang Y., Shi Y., Wang C. Fest J., Ruiter R., Mulder M., Groot Koerkamp B., Ikram M.A., Stricker B.H., van Eijck C.H.J. Huang J., Jiang Y., Li J., He S., Huang J., Pu K. Mi X., Zou B., Zou F., Hu J. Wang Y., Li Z., Lin Q., Wei Y., Wang J., Li Y., Yang R., Yuan Q. Yu C., Longfei L., Long W., Feng Z., Chen J., Chao L., Peihua L., Xiongbing Z., Hequn C. Laukhtina E., Shim S.R., Mori K., D'Andrea D., Soria F., Rajwa P., Mostafaei H., Compérat E., Cimadamore A., Moschini M., Teoh J.Y.-C., Enikeev D., Xylinas E., Lotan Y., Palou J., Gontero P., Babjuk M., Witjes J.A., Kamat A.M., Roupret M., Shariat S.F., Pradere B., European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group Years 2021 2019 2020 2019 2020 2020 2021 2019 2019 2021 Ref. (23) (24) (25) (26) (27) (28) (29) (30) (31) (32) Source title Cancer Discovery Cancer Dcience Journal of Cinical Investigation Journal of Cellular and Molecular Medicine International Journal of Cancer Angewandte Chemie - International Edition Nature Communications ACS Sensors Journal of Cellular Physiology European Urology Oncology Total citation (TC) 485 174 139 103 95 78 68 61 50 49 TC per year 121,25 29 27,8 17,17 19 15,6 17 10,17 8,33 12,25 Title Liquid biopsy: From discovery to clinical application Circulating miRNA panels for specific and early detection in bladder cancer Urine DNA methylation assay enables early detec- tion and recurrence monitoring for bladder cancer Evaluation of serum exosomal LncRNA-based biomarker panel for diagnosis and recurrence prediction of bladder cancer The systemic immune-inflammation index is associated with an increased risk of incident cancer – A population-based cohort study A renal-clearable macromolecular reporter for near-infrared fluorescence imaging of bladder cancer Permutation-based identification of important biomarkers for complex diseases via machine learning models Highly sensitive detection of bladder cancer-related miRNA in urine using time-gated luminescent biochip LncRNA PVT1 regulates VEGFC through inhibiting miR-128 in bladder cancer cells Diagnostic accuracy of novel urinary biomarker tests in non-muscle-invasive bladder cancer: A systematic review and network meta-analysis Figure 17. Keywords frequency over time. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 R. Falabella, V. De Simone, F. Crocetto, et al. 12 DISCUSSION To the best of the authors’ knowledge, this is the first bib- liometric analysis focusing on research based on new bio- markers in the diagnosis of bladder cancer from 2019 to 2024 over the last 6 years. The Scopus database was used to generate an eligible set of articles related to the topic field including only research articles from peer-reviewed journals to guarantee the high level of the publications analyzed. The six-year time interval taken into consideration was chosen with the aim of evaluating how research has evolved in the last period, how it is changing, and which are the most important and recent results. Several param- eters have been taken into consideration such as journals, the contribution of nations and organizations, citations, leading countries, author’s contributions and keywords. With the support of the bibliometric analysis and map- ping a better visualization of organizations and dynamics of science domains have been done to make a deep description of this scientific field and to provide predic- tions for future trends. The analysis revealed that the distribution of publications over the 6-year interval remained almost constant, high- lighting an ever-present interest in the field under study. An interesting finding of this bibliometric analysis was that most of the papers were published in the most influ- ential and pertinent journals, having a high impact factor, this underlining that the papers published are character- ized by a lot of citations. Even if some countries, like Egypt and India, published exclusively SCP-Type articles, other nations showed at least half of MCP-articles showing greater collaborations at an international level. This is the case of Greece with 66.6%, Italy with 53.8%, and Korea and France with 50% of MCP article. The number of citations of these MCP arti- cles underlined also the strong value of the publications on the field in analysis and the high impact on research. The main clusters of international collaborations and co- authorship were shown in Figure 8 and underlined how nations like Italy, the USA, China, Germany, and Japan had numerous collaborations while Egypt, Taiwan, Iraq, and India showed limited collaborations, this confirming the results of our analysis on their propension to SCP- articles. The journals which produced the greatest number of works were Cancers, International Journal of Molecular Sciences, and Frontiers in Oncology and they received a high number of citations, confirming their role in produc- ing highly impactful publications. Urologic Oncology: Seminars and Original investigations was the first purely urological Journal for publications in this field, with 13 works and 147 citations. It should be noted that the top ten journals published 21% of all publications identified by our analysis. Considering the number of national publications (Figure 9), China was the best publisher, with the highest num- ber of papers in this field (200), representing the 40% of all articles. The second country for the number of publi- cations was the USA with 41 articles (8.3%). Considering the pure number of citations, China is in the first place, but considering the country's production over time, Figure 10 showed how China, the USA, and Japan were the first publishers with a growing interest, followed by France and Iran that on the contrary obtained a high number of citations despite a lower production of articles. The explanation for this phenomenon is probably linked to different factors including, better or worse quality of the works, the different possibilities of accessing these works or the different temporal distribution of the articles with a consequent different impact on citations. However, considering the overall population of the dif- ferent countries, it is above all the European countries that have the greatest scientific production and also the greatest capillarity and resonance of the published works, as evidenced by the greater number of citations received. Affiliation Performance analysis details on author’s affilia- tions and most relevant institutes involved in the research. Peking University Shenzhein Hospital was the first publisher with 71 papers, followed by Zhongnan Hospital of Wuhan University and Shangai Jiao Tong University School of Medicine with respectively 38 and 37 papers, thus confirming that the main institutes corre- spond to the main country publisher (China). The analy- sis also confirmed the growing trend of publications of these institutes over the last 5 years, confirming the con- stant interest in the field of study. The Authors performance analysis showed the highest cited authors, underlining how there was a correspon- dence between the author with the greatest number of publications and the one with the greatest number of cita- tions, as shown in Table 5. A piece of fundamental importance in our research is rep- resented by document performance analysis which showed the most cited works. In the study of Alix-Panabierès C et al. (2021), enormous attention was given to the role of Circulating Tumor Cells (CTC) and Circulating Tumor DNA (ctDNA) as new bio- markers with clinical application in early cancer detec- tion, improved cancer staging, detection of relapse and monitoring of therapeutic efficacy (23). Usuba W et al. (2019) underlined the role of miRNa pro- files as a tool for liquid biopsy in bladder cancer screening and performed a global miRNA profiling of 392 serum samples of bladder cancer patients with 100 non-cancer samples and 480 samples of other cancers as controls, thus demonstrating that the 7-miRNA panel could be a biomarker for the specific and early detection of bladder cancer (24). In this research study, a careful choice of key- words (bladder cancer; circulating microRNA; diagnosis; early detection; liquid biopsy) has shown the real impor- tance and great impact of the topic of work. In the third most cited paper, Chen X et al. (2020) devel- oped a diagnostic model capable of identifying Bca-spe- cific methylation markers and compared it with cytology and FISH (25). With this model, they showed how urine tumor DNA methylation assessment for early diagnosis but also for minimal residual tumor detection and sur- veillance in Bca could be proposed as a rapid, noninva- sive, and promising approach to reduce the burden of invasive methods. The keyword performance analysis showed the most rel- evant words used in the papers and their frequency over time. Considering also the frequency over the years, there was a growing use of the words urine, liquid biopsy, Archivio Italiano di Urologia e Andrologia 2025; 97(1):13396 13 New biomarkers for diagnosis of bladder cancer methylation, and miRna that confirm that the research hotspots are supported by the interest in novel biomark- ers for the diagnosis of BC. In this analysis, the choice to exclude the keywords used in the first search was dictated by the desire to increase the appropriateness of the article selection. In this way, it was possible to highlight keywords such as liquid biopsy, miRNA, and urine, useful for understanding which type of research the various authors were leaning towards. These results have underlined the trend of research towards non-invasive diagnostic approaches such as uri- nalysis and liquid biopsy. The growing use of these words is also confirmed by the analysis of the frequency of their use in literature over the years, thus underlining that the research hotspots are supported by the interest in identifying new diagnostic methods and new biomarkers in the diagnosis of BC. CONCLUSIONS This bibliometric analysis demonstrated that research on biomarkers in BC is in rapid evolution. Nonetheless, this study has limitations, since we have used only one data- base, namely the Scopus database which does not repre- sent the entire literature, and some articles not indexed could not be included. However, bibliometric analyses are a precise instrument in the field of medicine, giving us the possibility to better understand the evolution of lit- erature, the collaborations, and the value of the papers published. Furthermore, it highlighted the links between the various nations, institutes, and authors, bringing to light the great value of collaboration between the differ- ent structures. From a clinical point of view, this bibliometric analysis has shown, through the articles taken into consideration, the propensity of the research towards non-invasive methods of diagnosis of bladder carcinoma that could support or replace conventional diagnostic methods. 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Correspondence Roberto Falabella, MD rfalabella@libero.it Vincenzo Francesco Caputo, MD (Corresponding Author) vincitor@me.com Unit of Urology, AOR San Carlo, Potenza, Italy Via Potito Petrone 85100 Potenza, Italy Valentina De Simone vadesimone@unisa.it Valentina Di Pasquale vdipasquale@unisa.it Department of Industrial Engineering, University of Salerno, Italy Felice Crocetto, MD Felice.crocetto@unina.it Unit of Urology, Department of Neurosciences, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy Francesco Del Giudice, MD Francesco.delgiudice@uniroma1.it Department of Maternal infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto 1 Hospital, Rome, Italy Angelo Porreca, MD angeloporreca@gmail.com Oncological Urology, Veneto Institute of Oncology (IOV). IRCCS, Padua, Italy Biagio Barone, MD Biagio.barone@aslnapoli1centro.it Department of Urology, P.O. San Paolo, Asl Na1 Centro, 80125, Naples, Italy Nazario Foschi, MD nazario.foschi@policlinicogemelli.it Luca Di Gianfrancesco, MD dr.lucadigianfrancesco@gmail.com Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy