A specific scoring system able to predict the efficacy of the therapy for bladder cancer: why not?
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I would like to congratulate Soria et al.  on their recent review focused on the role of urine-, tissue- and blood-based markers in diagnosing bladder cancer (BC). The authors analyzed the standard and novel markers demonstrating that there is little and often poor evidence to justify the use of a single specific marker in clinical practice.
As underlined by the above authors and reported in some other studies, the use of a comprehensive pathway of different tests may be more useful in clinical care rather than a single marker: a combination of the analysis of different markers could improve the general sensitivity and specificity of BC diagnosis, through the evaluation of the different functional targets of each analyzed parameter .
This strategy may be extremely useful not only in finding BC at early stage, but also (and above all) in monitoring the response to local/systemic therapies.
The definition of a specific pathway of biochemical markers which are highly efficacious in the early identification of patients as ‘non-responders’ to the treatment may be crucial to make them candidate to a more radical therapy earlier, such as radical cystectomy, thereby reducing the risk of a localized progression and/or a distant metastasizing.
Moreover, the accuracy of a similar multiple test could be increased by adding other parameters well known to be predictors of response/non-response to the therapy: for example, in our experience in patients affected by non-muscle invasive BC, treated with bladder instillation of BCG, we demonstrated, in a large cohort, that there are some factors which do not influence the efficacy of the treatment such as age , while others, such as hypertension , are significantly correlated to a poor response to immunotherapy.
Multicenter studies focused on this topic could define the specific single “weight” of each parameter more successfully, thus allowing the creation of a specific scoring system able to predict the efficacy of the therapy better and consequently ‘tailoring’ the best radical intervention on the best patient.
Protocol/project development: Fabrizio Dal Moro; manuscript writing/editing: Fabrizio Dal Moro.
Compliance with ethical standards
Conflict of interest
The author declares that he has no conflict of interest.
- 4.Dal Moro F, Bovo A, Crestani A, Vettor R, Gardiman MP, Zattoni F (2015) Effect of hypertension on outcomes of high-risk patients after BCG-treated bladder cancer: a single-institution long follow-up cohort study. Medicine (Baltimore) 94:e589. https://doi.org/10.1097/MD.0000000000000589 CrossRefGoogle Scholar