Abstract
PurposeUse of molecular markers in urine, tissue or blood offers potential opportunities to improve understanding of bladder cancer biology which may help identify disease earlier, risk stratify patients, improve prediction of outcomes or help target therapy.MethodsA review of the published literature was performed, without restriction of time.ResultsDespite the fast-growing literature about the topic and the approval of several urinary biomarkers for use in clinical practice, they have not reached the level of evidence for widespread utilization. Biomarkers could be used in different clinical scenarios, mainly to overcome the limitations of current diagnostic, predictive, and prognostic tools. They have been evaluated to detect bladder cancer in asymptomatic populations or those with hematuria and in surveillance of disease as adjuncts to cystoscopy. There is also a potential role as prognosticators of disease recurrence, progression and survival both in patients with non-invasive cancers and in those with advanced disease. Finally, they promise to be helpful in predicting the response to local and/or systemic chemotherapy and/or immunotherapy.ConclusionsTo date, due to the lack of high-quality prospective trials, the level of evidence provided by the current literature remains low and, therefore, the potential of biomarkers exceeds utilization in clinical practice.
Highlights
Bladder cancer (BCa) is a heterogeneous disease with significant diagnostic, therapeutic and prognostic challenges [1]
Molecular markers detected in urine, tissue or blood offer promising opportunities to improve our understanding of biology of a specific cancer and its micro- and macroenvironment
Part of the SIU–ICUD update on BCa, we review the challenges of introducing markers into clinical care and discuss urine, tissue- and blood-based markers for different stages of disease and different clinical scenarios
Summary
Bladder cancer (BCa) is a heterogeneous disease with significant diagnostic, therapeutic and prognostic challenges [1]. Tissue biomarkers can theoretically be used in NMIBC to predict oncological outcomes such as recurrence and progression as well as the response to intravesical BCG and, ideally, could be used to improve individualized treatment and surveillance based on individualized risk profiles They can be useful to identify the proportion of high-risk NMIBC patients who are likely to develop disease progression to invasive disease, requiring consideration for intensified therapy such as early radical cystectomy. The study noted that patients with one or more CTCs had a shorter time to disease recurrence and shorter CSS than those with none [74] These findings were are found in a larger cohort of 100 consecutive patients with non-metastatic BCa undergoing radical cystectomy [75].despite these encouraging results, the use of blood- and tissue-based biomarkers for prediction and guidance of clinical decision-making in MIBC is still too immature due to the weak strength of evidence of published studies. Use of biomarkers to predict the response to systemic immunotherapy remains limited; a significant proportion of patients with negative biomarkers status still respond to treatment and many patients with positive biomarkers status fail to respond
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