LAUSR

Transl Cancer Res 2019;8(Suppl 2):S176-S179 tcr.amegroups.com Perioperative cisplatin-based combination chemotherapy is a first-line treatment strategy for muscle-invasive bladder cancer (MIBC) patients with or without metastasis. According to current European Association of Urology (EAU) guidelines, the use of neoadjuvant chemotherapy (NAC) is strongly recommended to patients with clinical T2–T4a and N0M0 disease (1). However, existing data show that NAC provides only an 8% absolute survival benefit at five years, which means that 12 patients have to be treated with NAC to avoid one death in five years (2). This demonstrates that only a smaller group of patients benefit from NAC treatment. This survival benefit is restricted to pathological responders, who show partial or complete response. In addition, novel effective immunotherapy agents are now available for cisplatin resistant and cisplatin ineligible MIBC patients. Therefore, there is an urgent and unmet need for biomarkers in order to predict response to cisplatin chemotherapy. In their study Pietzak et al. divided patients into groups of “primary” MIBC (patients who had MIBC at first diagnosis) and “secondary” MIBC (who were diagnosed with a nonmuscle invasive bladder cancer and progressed to MIBC) and found that secondary MIBC patients experienced lower survival rates after NAC treatment compared to patients with primary MIBC (3). In addition, they demonstrated that patients that do not exhibit a pathologic response to NAC had inferior survival rates compared to patients who were only treated by radical cystectomy without NAC. This suggests that patients who are not responsive to cisplatin have a better chance of survival with upfront cystectomy without NAC. This observation is important and further highlights the need for prediction of cisplatin therapy. Urinary bladder cancer in most cases manifests as urothelial carcinoma which is a heterogeneous disease regarding its morphological and histological appearance as well as its clinical behavior. About 70% of BCs are nonmuscle-invasive (NMIBC) at first presentation, while 30% of patients already have muscle-invasive disease (MIBC). These two groups of patients show characteristic differences regarding their clinical behavior as well as morphological, histological and molecular features. NMIBC patients are usually treated with transurethral resection and have an excellent prognosis with a survival rate of over 90% after five years. NMIBCs often recur but rarely progress. In contrast, MIBC patients have a survival rate of only 50% after five years. MIBC patients are usually treated with radical cystectomy and perioperative, adjuvant or NAC. NMIBCs mostly appear as papillary disease while MIBC predominantly shows higher tumor burden and in almost all cases a high-grade morphology with more solid growth patterns [for the usual/not-otherwise specified (NOS) type] or variant differentiation as for example micropapillary, squamous or plasmacytoid patterns which can be detected in up to one third of cases and are associated with Editorial