Molecular biomarkers in bladder preservation therapy for muscle-invasive bladder cancer

Lancet Oncol. 2018 Dec;19(12):e683-e695. doi: 10.1016/S1470-2045(18)30693-4.


Although muscle-invasive bladder cancer is commonly treated with radical cystectomy, a standard alternative is bladder preservation therapy, consisting of maximum transurethral bladder tumour resection followed by radiotherapy with concurrent chemotherapy. Although no successfully completed randomised comparisons are available, the two treatment paradigms seem to have similar long-term outcomes; however, clinicopathologic parameters can be insufficient to provide clear guidance in the selection of one treatment over the other. Recent advances in the molecular understanding of bladder cancer have led to the identification of new predictive biomarkers that ultimately might help guide the tailored selection of therapy on the basis of the intrinsic biology of the tumour. In this Review, we discuss the existing evidence for molecular alterations and genomic signatures as prognostic or predictive biomarkers for bladder preservation therapy. If validated in prospective clinical trials, such biomarkers could enable the identification of subgroups of patients who are more likely to benefit from one treatment over another, and guide the use of combination therapies that include other modalities, such as immunotherapy, which might act synergistically with radiotherapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Biomarkers, Tumor / genetics*
  • Chemotherapy, Adjuvant
  • Clinical Decision-Making
  • Cystectomy* / adverse effects
  • Cystectomy* / mortality
  • Humans
  • Liquid Biopsy
  • Molecular Diagnostic Techniques*
  • Molecular Imaging
  • Neoplasm Invasiveness
  • Organ Sparing Treatments / adverse effects
  • Organ Sparing Treatments / methods*
  • Organ Sparing Treatments / mortality
  • Precision Medicine / adverse effects
  • Precision Medicine / methods*
  • Precision Medicine / mortality
  • Predictive Value of Tests
  • Risk Factors
  • Treatment Outcome
  • Urinary Bladder Neoplasms / genetics*
  • Urinary Bladder Neoplasms / mortality
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / therapy*


  • Biomarkers, Tumor