Immunohistochemical prognostic markers in bladder cancer

The management of superficial bladder cancer is characterized by early recognition of recurrence and the prevention of progression. Biological markers must provide additional information to that provided by multiplicity, size and grade. So, the identification of new prognostic biomarkers for bladder cancer could be used to divide patients into risk groups determining treatment and follow-up schemes. The transformation of a normal cell into a malignant cell is a multistep mechanism, which involves various alterations on the molecular and genetic level. Transitional-cell carcinoma (TCC) is believed to arise through a series of genetic changes. One mechanism of these changes is the mutation of normal genes to oncogenes, which allows cells to escape the regulation of cellular growth control. In addition, tumour growth is regulated by a balance between proliferation, growth arrest and programmed cell death. The control of growth arrest and apoptosis plays key roles in the development of human cancer and in cancer treatment. Tumours present a complex ecosystem in which interactions between tumour cells, extracellular matrix and host cells may lead to reciprocal influences resulting in tumour promotion, invasion and metastasis. Tumour invasion is considered to be a dynamic complex process, which involves a number of steps. During these steps, a lot of critical molecules are involved, the expression of which may offer useful information about the biological behavior of bladder cancer. This review article summarizes the most promising immunohistochemical prognostic factors which have been considered to be involved in the complex and multistep process of bladder carcinogenesis, and in the process of invasion and metastasis.