Response to editorial comment from Dr Todenhöfer and Dr Schwentner to recurrence and progression in patients with non-muscle invasive bladder cancer: prognostic models including multicolor fluorescence in situ hybridization molecular grading.

Abstract

Our group has analyzed the usefulness of cytology, immunocytology (ucyt+) and multitarget-fluorescence in situ hybidization (FISH) in the context of bladder cancer (BC) disease diagnosis and progression prediction. We still strongly believe in the usefulness of cytology in clinical practice, and in its value in progression and recurrence prognostication as reported in a recent publication. 1 Nevertheless, this is especially true in high-grade tumor patients in whom cytology shows the best sensitivity and specificity. When we exclude G3 and cis BC, cytology does not have the same sensitivity and specificity. For this reason, we addressed our interest on the multitargetFISH technique, which is more sensitive even in low- and intermediate-grade tumors. Treatment and follow up for BC is already particularly expensive. The addition of new or old tumor markers should therefore have a minimum impact on the cost of disease management, and should have a great impact on controlling the disease. In the case of multitarget-FISH, we decided not to use it in the detection setting, but in the prognostication setting, so that the cost of the test could be justified by the change of the treatment strategies. Multitarget-FISH was introduced and approved by the FDA in 2001, but after this, several large-scale whole genome array analyses were carried out. 2,3 A critical evaluation of the more recent data has changed the genomic regions involved in BC evolution. Additional genomic regions that are altered preferentially in aggressive tumors include gains of 5p and 6p (associated with the oncogene, E2F3), and the losses of 17p (associated with the tumor suppressor gene, TP53) and 13q (associated with the tumor suppressor gene RB1). The loss of 8p23 was reported to also correlate to prognosis, and is not included in the FISH Urovysion test. 4