Tumour node metastasis staging of bladder cancer: prognosis versus pitfalls

The WHO classification of urothelial cancer in 2004 has made changes based on the insights of molecular genetics, indicating bladder cancer with entities that are genetically stable versus those that are genetically instable. Seen as work in progress, the need of further validation is obvious. Clinical studies based on solid histological diagnosis are as necessary as the definition of more molecular features of bladder cancer.

Solid histological diagnosis includes sufficient clinical information and adequate tissue processing. This combined with molecular data will lead to a more clear-cut distinction between benign and malignant and possibly to another change in terminology with higher concordance to other epithelial tumours. Whereas the identification of FGFR3 mutations has led to a better distinction of at least two pathways of urothelial carcinogenesis, additional multiparametric approaches may help improve the still inadequate search for urine and blood markers indicative of bladder cancer and/or its progression. Proteomic profiling, sets of epigenetic markers, and micro RNAs will be given as examples.

Recent data mainly support the concept of the WHO 2004 classification of bladder cancer. We are optimistic that an even more clear-cut distinction between benign recurring, nonprogressing tumours and more aggressive tumours will enable us to focus and limit chemotherapy.