Intermediate-risk urothelial carcinoma: an unresolved problem?

Area of Science:

• Urology
• Oncology
• Cytogenetics

Background:

• Optimal therapy and follow-up for intermediate-risk urothelial neoplasms remain debated.
• Biologic characterization is needed to stratify patients effectively.

Purpose of the Study:

• To characterize urothelial neoplasms in intermediate-risk patients using multicolor-fluorescence in situ hybridization (FISH).
• To develop a novel follow-up algorithm based on chromosomal patterns.
• To report preliminary results of this new approach.

Main Methods:

• 51 patients with intermediate-risk urothelial carcinoma underwent urine-based cytology and multicolor-FISH (Urovysion).
• FISH analysis evaluated chromosomal patterns, including p16 loss and aneuploidy of chromosomes 3, 7, and 17.
• Patients were followed for a mean of 14.2 months.

Main Results:

• Of 49 evaluable patients, 14 were FISH-negative (diploid).
• 20 patients showed p16 loss and/or chromosome 3 aneuploidy.
• 15 patients had chromosome 7 and/or 17 aneuploidy.
• Recurrence rates were 14.3% in FISH-negative, 15.0% in p16/3-positive, and 60.0% in 7/17-positive groups.

Conclusions:

• The Urovysion test predicts urothelial cancer's biologic behavior.
• This facilitates personalized follow-up for intermediate-risk patients.
• Patients can be stratified into low-risk or high-risk monitoring schemes based on chromosomal patterns.