van Rhijn Bas W G, Catto James W, Goebell Peter J, Knüchel Ruth, Shariat Shahrokh F, van der Poel Henk G, Sanchez-Carbayo Marta, Thalmann George N, Schmitz-Dräger Bernd J, Kiemeney Lambertus A
Division of Urology, Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Institute for Cancer Studies and Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom.
Urol Oncol. 2014 Oct;32(7):1078-87. doi: 10.1016/j.urolonc.2014.07.002. Epub 2014 Sep 10.
To summarize the current status of clinicopathological and molecular markers for the prediction of recurrence or progression or both in non-muscle-invasive and survival in muscle-invasive urothelial bladder cancer, to address the reproducibility of pathology and molecular markers, and to provide directions toward implementation of molecular markers in future clinical decision making.
Immunohistochemistry, gene signatures, and FGFR3-based molecular grading were used as molecular examples focussing on prognostics and issues related to robustness of pathological and molecular assays.
The role of molecular markers to predict recurrence is limited, as clinical variables are currently more important. The prediction of progression and survival using molecular markers holds considerable promise. Despite a plethora of prognostic (clinical and molecular) marker studies, reproducibility of pathology and molecular assays has been understudied, and lack of reproducibility is probably the main reason that individual prediction of disease outcome is currently not reliable.
Molecular markers are promising to predict progression and survival, but not recurrence. However, none of these are used in the daily clinical routine because of reproducibility issues. Future studies should focus on reproducibility of marker assessment and consistency of study results by incorporating scoring systems to reduce heterogeneity of reporting. This may ultimately lead to incorporation of molecular markers in clinical practice.
总结用于预测非肌层浸润性尿路上皮膀胱癌复发或进展或两者情况以及肌层浸润性尿路上皮膀胱癌生存情况的临床病理和分子标志物的现状，探讨病理和分子标志物的可重复性，并为未来临床决策中分子标志物的应用提供方向。
以免疫组织化学、基因特征以及基于FGFR3的分子分级作为分子实例，重点关注预后以及与病理和分子检测稳健性相关的问题。
由于目前临床变量更为重要，分子标志物在预测复发方面的作用有限。使用分子标志物预测进展和生存具有很大潜力。尽管有大量关于预后（临床和分子）标志物的研究，但病理和分子检测的可重复性研究不足，缺乏可重复性可能是目前个体疾病结局预测不可靠的主要原因。
分子标志物有望预测进展和生存，但不能预测复发。然而，由于可重复性问题，这些标志物均未用于日常临床实践。未来的研究应通过纳入评分系统以减少报告的异质性，关注标志物评估的可重复性和研究结果的一致性。这最终可能会使分子标志物纳入临床实践。
