Unlocking the potential of long non-coding RNAs in bladder cancer

Bladder cancer (BC) is a prevalent urinary tract malignancy, characterized by high recurrence rates and heterogeneous disease progression. Non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) present distinct clinical challenges, and conventional clinicopathological parameters are often insufficient to predict recurrence or progression accurately. Long non-coding RNAs (lncRNAs) have emerged as key regulators of tumor biology, influencing proliferation, migration, epithelial-mesenchymal transition, and therapy resistance, with potential in risk stratification, prognostic prediction and guidance of therapy de-escalation or intensification.

This narrative review examines the role of lncRNAs in BC, focusing on their biological functions, prognostic significance, and potential to guide personalized treatment strategies. We discuss lncRNA involvement in NMIBC and MIBC, highlight molecular profiling studies enabling risk stratification and molecular subtyping for guiding treatment de-escalation or intensification. Finally, we address the challenges and future directions for integrating lncRNA profiling into routine clinical practice.

LncRNAs offer a promising approach for precision oncology in bladder cancer, providing insights beyond traditional clinical parameters. Integrating lncRNA profiling into routine practice could optimize risk stratification, guide therapy intensity, and reduce overtreatment. Although current evidence is encouraging, large-scale prospective trials are needed to validate lncRNA signatures and fully realize their potential in personalized bladder cancer management.