Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Urol Oncol. 2012 Jul-Aug;30(4):518-23. doi: 10.1016/j.urolonc.2012.04.002.
Non-muscle-invasive (NMI) bladder cancer (BC) is a chronic disease with varying oncologic outcomes requiring frequent follow-up and repeated treatments. Recurrence (in up to 80%) is the main problem for pTa NMI-BC patients, whereas progression (in up to 45%) is the main threat in pT1 and carcinoma in situ (CIS) NMI-BC. In a recent European Organization for Research and Treatment of Cancer (EORTC) analysis, multiplicity, tumor-size and prior recurrence rate are the most important variables for recurrence. Tumor grade, stage, and CIS are the most important variables for progression to muscle-invasive (MI)-BC. However, reproducibility of pathologic stage and grade is modest, which is a major concern to clinicians. Molecular markers are promising for predicting clinical outcome of NMI-BC, especially because clinicopathologic variables are not sufficient for individual prediction of prognosis. Several obstacles and opportunities have been linked to molecular markers. The role for molecular markers to predict recurrence seems limited because multifocal disease and incomplete treatment probably are more important for recurrence than the molecular features of a removed tumor. Prediction of progression with molecular markers holds considerable promise. Examples are the combination of immunohistochemical markers, gene expression signatures, and molecular grade (based on FGFR3 mutation status and Ki-67 expression). Nevertheless, the value of molecular markers over clinicopathologic indexes is still being questioned and their clinical use limited. One of the reasons may be that reproducibility of prognostic (clinical and molecular) markers in NMI-BC has been understudied.
非肌肉浸润性（NMI）膀胱癌（BC）是一种具有不同肿瘤学结局的慢性疾病，需要频繁随访和反复治疗。复发（高达 80%）是 pTa NMI-BC 患者的主要问题，而进展（高达 45%）是 pT1 和原位癌（CIS）NMI-BC 的主要威胁。在最近的欧洲癌症研究与治疗组织（EORTC）分析中，多发性、肿瘤大小和先前复发率是复发的最重要变量。肿瘤分级、分期和 CIS 是进展为肌肉浸润性（MI）-BC 的最重要变量。然而，病理分期和分级的可重复性不高，这是临床医生关注的主要问题。分子标志物在预测 NMI-BC 的临床结局方面具有很大的潜力，尤其是因为临床病理变量不足以对预后进行个体化预测。与分子标志物相关的存在一些障碍和机会。分子标志物预测复发的作用似乎有限，因为多发病灶和治疗不彻底可能比切除肿瘤的分子特征更重要。用分子标志物预测进展具有很大的潜力。例如，免疫组织化学标志物、基因表达特征和分子分级（基于 FGFR3 突变状态和 Ki-67 表达）的组合。然而，分子标志物相对于临床病理指标的价值仍存在争议，其临床应用也受到限制。原因之一可能是 NMI-BC 中预后（临床和分子）标志物的可重复性研究不足。
