What are molecular markers for bladder cancer?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

An ideal molecular marker for bladder cancer would enhance diagnostic, prognostic, and therapeutic capabilities. Some urine-based tests are currently available, but large prospective randomized trials are needed to evaluate the prognostic benefits of these modalities.

Current investigation includes blood group antigens, tumor-associated antigens (bladder tumor antigen [BTA], nuclear matrix protein [NMP-22]), markers of cellular proliferation (Ki-67, proliferating cellular nuclear antigen [PCNA]), peptide growth factors (epidermal growth factor [EGF], fibroblast growth factor [FGF], transforming growth factor [TGF]), adhesion molecules (integrin), angiogenesis modifiers (FGF, vascular endothelial growth factor [VEGF], thrombospondin-1, angiostatin), apoptotic factors (Caspase-3, Bcl-2, Fas, survivin), oncogenes (c-H-ras, c-myc), and tumor suppressor genes (RB, TP53, p21, p27). [46, 47] Identification of such a marker would assist in recognizing recurrences, estimating tumor aggressiveness, and guiding therapy.

Recently, the combination of p53, p21, pRb, and p16 immunoreactivity has been shown to be strongly correlated with tumor recurrence and survival following radical cystectomy. The addition of the number of altered biomarkers to bladder cancer nomograms has been shown to increase predictive accuracy for both recurrence and cancer-specific mortality. Others have developed a quantitative PCR signature consisting of 57 genes that may classify high- versus low-risk T1 cases; patients considered to have a high-risk signature had a 45% rate of progression to T2 disease at 2 years, whereas low-risk patients had a 12% rate. [48] Lastly, urinary detection of cytogenetic abnormalities via fluorescence in situ hybridization (FISH) has proven promising in predicting tumor recurrence (UroVysion, Vysis, Downers Grove, Illinois). [49] Future oncologic care will no doubt include contributions from molecular medicine.


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