Risk Stratification in Superficial Bladder Cancer: Fact or Fiction

Non-muscle-invasive bladder cancer is a heterogeneous group of tumors with completely different oncological outcome. What is more, their oncogenesis runs along different pathways with different oncological potential. The actual EORTC- risk tables are currently the best tool for counselling patients. They do not however, take tumor biology into account and the single factors used have multiple underlying errors.It seems possible to assess the biological behavior of urothelial carcinomas more accurately using the FISH technique. Based on previous studies patients with a diploid chromosomal pattern, or only p16 and/or chromosome 3 positivity, can be considered as low-risk for recurrence/progression, whereas patients with a chromosomal pattern including aberrations of chromosomes 7 and/or 17 should be considered as high risk. In fact, patients with a high-risk chromosomal pattern have a significantly shorter disease-free survival time and higher progression rate compared to patients with a low-risk pattern.Patients at high risk could therefore, be treated more aggressively to prevent tumor spreading and metastasis, if this is identified at an early stage of the disease; low risk patients on the other hand, might be spared aggressive treatment and followed-up at longer intervals. Furthermore, new prognostic parameters could provide additional arguments for therapeutic decisions in those cases where conventional prognostic parameters point to divergent prognostic outcomes.These ongoing clinical implications must be considered experimental and need the proof of time. Nevertheless, it is a new approach along with that of morphology and biometric. But a reliable risk stratification is as yet unattainable and remains a chimera.