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Urologic Oncology pp 1–14Cite as

Risk Stratification and Prognostication of Bladder Cancer

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Abstract

Bladder cancer (BC) is divided into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). The majority of NMIBCs are treated conservatively and primary prognostic outcomes are progression and recurrence. The strongest prognostic factors for progression are T-classification, presence of carcinoma in situ (CIS), and tumor grade, while recurrence is associated with tumor multifocality, size, and prior recurrence rate. The European Organisation for Research and Treatment of Cancer (EORTC) and Club Urológico Español de Tratamiento Oncológico (CUETO) have independently created prognostic models for NMIBC, based on different populations. Despite their prognostic value in NMIBC in general, T1 BC remains perilous disease for which adequate risk stratification is lacking.

Nonmetastatic MIBC usually requires a radical cystectomy (RC), preferably combined with neoadjuvant chemotherapy (NAC). The most important prognosticators for survival are pT- and pN-classification and lymphovascular invasion (LVI). Additional poor prognostic factors found in individual studies are progression from NMIBC, variant histology, hydronephrosis, positive surgical margins at RC, and tumor localization in the bladder trigone. A few clinical risk models for MIBC have been created, but not validated, in order to identify patients who might benefit from NAC. NAC has a positive impact on survival, especially if a complete response is observed at RC. Research aimed at predicting NAC response has mainly focused on molecular markers in TUR specimens by means of immunohistochemistry and genome signatures. Recently, the distinctive subtypes basal and luminal BC have been discriminated. These subtypes appear to be both prognostic and predictive of NAC response but require further validation.

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Authors and Affiliations

  1. Departmentof Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Elisabeth E. Fransen van de Putte & Bas W. G. van Rhijn

  2. Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany

    Maximilian Burger & Bas W. G. van Rhijn

Authors
  1. Elisabeth E. Fransen van de Putte
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  2. Maximilian Burger
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  3. Bas W. G. van Rhijn
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Correspondence to Elisabeth E. Fransen van de Putte .

Editor information

Editors and Affiliations

  1. Dept. of Urology & Urologic Oncology, Hannover Medical School, Hannover, Germany

    Axel S. Merseburger

  2. Dept. of Urology, University of Regensburg St. Josef Medical Centre, Regensburg, Germany

    Maximilian Burger

Section Editor information

  1. der Universität Regensburg, Oberarzt der Klinik für Urologie, Regensburg, Germany

    Wolfgang Otto

  2. Departement of Urology, Weill Cornell Medical Center, New York, NY, USA

    Shahrokh F. Shariat

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van de Putte, E.E.F., Burger, M., van Rhijn, B.W.G. (2018). Risk Stratification and Prognostication of Bladder Cancer. In: Merseburger, A., Burger, M. (eds) Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42603-7_28-1

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  • DOI: https://doi.org/10.1007/978-3-319-42603-7_28-1

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