Editorial Comment from Dr Todenhöfer and Dr Schwentner to Recurrence and progression in patients with non‐muscle invasive bladder cancer: Prognostic models including multicolor fluorescence in situ hybridization molecular grading
2014-06-19

To date, the use of urine markers in the follow up of patients with non-muscle invasive bladder cancer (NMIBC) has not been clearly defined. A couple of studies have focused on urine markers as a potential alternative to cystoscopy during follow up. Only little is known on the prognostic role of urine marker changes before transurethral-resection of a bladder tumor (TUR-BT). In the current issue of this journal, the study group from Bolzano, Italy, present a work aiming to evaluate the prognostic value of a model including chromosomal aberrations in urinary cells of patients with intermediate-risk NMIBC.1 The authors observed that patients with aneuploidy of chromosome 7 and 17 at the time of TUR-BT had a higher risk of recurrence and progression during the median follow up of 67 months. They state that the application of their model and the assessment of chromosomal aberrations using the UroVysion assay could help to identify those patients with intermediate risk bladder cancer (according to European Organization for the Research and Treatment of Cancer risk tables) that have an increased risk of recurrence and progression, and might benefit from more aggressive intravesical therapy. The prognostic role of chromosomal aberration patterns in urine samples from patients undergoing follow up for NMIBC has been assessed in two other studies by the same study group.2, 3 In both studies, the presence of aneuploidy in chromosome 7 or 17 was associated with unfavorable prognosis. However, in none of the studies did the authors provide information on conventional urine cytology results. Why could that be helpful? We assessed the prognostic role of urine cytology, immunocytology (uCyt+), UroVysion fluorescence in situ hybridization and NMP22 enzyme-linked immunosorbent assay in 112 patients with negative cystoscopy during follow up for NMIBC who underwent simultaneous testing for all four markers.4 We observed that all urine markers were predictive of recurrence and progression in univariable analysis. However, when focusing on patients with negative urine cytology, only NMP22 was predictive for recurrence and progression. Certainly, these results cannot be directly transferred to the present study, as we applied other criteria for a positive UroVysion test (≥4 out of 25 morphological suspicious cells had to show ≥3 signals of at least two chromosomes 3, 7, 17 or at least 12 nuclei had to show no signal of 9p21 for a test to be positive), and also included patients with low- and high-risk tumors (according to European Organization for the Research and Treatment of Cancer tables). However, we and others have shown that in studies assessing the prognostic value of chromosomal aberrations in urinary cells, the parallel application of urine cytology strongly helps the reader to see whether a relatively expensive test shows better performance with regards to calculating the risk of recurrence and progression than cytology, which is cheap and broadly available.5 In the present case, the applied molecular classification is predictive of recurrence and progression irrespective of the cytology result, and the authors have to be congratulated for a very interesting tool that might be used for more individual approaches in the application of intravesical therapy and the surveillance of patients with intermediate-risk NMIBC after validation in a larger cohort. None declared.