PROGNOSTIC MARKERS IN BLADDER-CANCER - A CONTEMPORARY REVIEW OF THE LITERATURE

Purpose: We provide a contemporary review of bladder tumor markers and summarize their role as prognostic indicators. Materials and Methods: A comprehensive review of the literature on prognostic markers for tr ansitional cell carcinoma of the bladder was performed. Results: Inten se research efforts are being made to identify and characterize better various bladder cancers and their true biological potential. The need to predict which superficial tumors will recur or progress and which invasive tumors will metastasize has led to the identification of a va riety of potential prognostic markers. Blood group antigens, tumor ass ociated antigens, proliferating antigens, oncogenes, peptide growth fa ctors and their receptors, cell adhesion molecules, tumor angiogenesis and angiogenesis inhibitors, and cell cycle regulatory proteins have recently been identified. The potential clinical applications of these tumor markers are under active investigation. Recent attention has fo cused on which tumor markers may predict the responsiveness of a parti cular bladder cancer to systemic chemotherapy. Conclusions: At present conventional histopathological evaluation of bladder cancer (tumor gr ade and stage) cannot predict accurately the behavior of most bladder tumors. With a better understanding of the cell cycle, and cell to cel l and cell to extracellular matrix interactions as well as improved di agnostic techniques (immunohistochemistry), progress is being made to identify and characterize other potential prognostic markers for trans itional cell carcinoma of the bladder. The ultimate goal is to develop reliable prognostic markers that will accurately predict not only the course but also the response of a tumor to therapy. This information may then be used to dictate more aggressive treatment for tumors that are likely to progress and less aggressive treatment for those that ar e unlikely to progress. In the future these biological markers may als o be used in gene therapy for the treatment of bladder cancer.