Risk and Prognostic Factors- a Pathologist's Perspective

Great strides have been made in the genetic and molecular genetic characterization of solid tumors, including bladder cancer. As knowledge in this area continues to grow, the new information can be used to classify tumors, establish prognosis, and guide therapy in a more precise fashion. Although several molecular alterations have been associated with advanced stage and aggressive behavior, their use in a routine clinical setting remains controversial because none of the changes have been confirmed in a prospective randomized fashion. In addition, the methodology to perform these tests has not been standardized, and there is no consensus on cut-off points to interpret the results. For the foreseeable future, therapy for urothelial cancer will be based on a host of clinical and pathologic factors. This fact places a great burden of responsibility on the pathologist who must strive for diagnostic accuracy and to identify those morphologic features of the tumor that are relevant in predicting aggressive disease, clinical outcome, and response to therapy. Included in this process is a constant questioning and refining of criteria in an attempt to make a subjective yet powerful discipline even more relevant for clinical care. As new techniques and concepts emerge, they must be submitted to rigorous scientific scrutiny, including prospective validation and multivariate analysis in which new putative BLADDER