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Risk Stratification and Prognostication of Bladder Cancer

  • Elisabeth E. Fransen van de PutteEmail author
  • Maximilian Burger
  • Bas W. G. van Rhijn
Living reference work entry

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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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Elisabeth E. Fransen van de Putte
    • 1
    Email author
  • Maximilian Burger
    • 2
  • Bas W. G. van Rhijn
    • 1
    • 2
  1. 1.Departmentof Surgical Oncology (Urology)Netherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of UrologyCaritas St. Josef Medical Centre, University of RegensburgRegensburgGermany

Section editors and affiliations

  • Wolfgang Otto
    • 1
  • Shahrokh F. Shariat
    • 2
  1. 1.der Universität RegensburgOberarzt der Klinik für UrologieRegensburgGermany
  2. 2.Departement of UrologyWeill Cornell Medical CenterNew YorkUSA

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