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Clinical implications of molecular subtyping in bladder cancer

Satyal, Uttama; Sikder, Rahmat K.a; McConkey, Davidb; Plimack, Elizabeth R.c; Abbosh, Philip H.a,d

doi: 10.1097/MOU.0000000000000641
CANCER GENETICS IN UROLOGIC PRACTICE: Edited by Todd M. Morgan and Brian Chapin

Purpose of review The purpose of this review is to examine and evaluate similarities and differences in bladder cancer expression subtypes and to understand the clinical implications of the molecular subtyping.

Recent findings Four independent classification systems have been described, and there are broad similarities among the subtyping callers. Two major subtypes have been identified, that is, luminal and basal, with underlying subcategories based on various distinct characteristics. Luminal tumors generally bear a better prognosis and increased survival than basal tumors, although there is subtle variation in prognosis among the different subtypes within the luminal and basal classifications. Clinical subtyping is now commercially available, although there are limitations to its generalizability and application.

Summary Expression subtyping is a new method to personalize bladder cancer management. However, there is probably not sufficient evidence to incorporate use into current standards-of-care. Validation cohorts with clinically meaningful outcomes may further establish the clinical relevance of molecular subtyping of bladder cancer. Additionally, genetic alterations in bladder cancer may ‘color’ the interpretation of individual tumors beyond the expression subtype to truly personalize care for bladder cancer.

aMolecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania

bJohns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland

cDepartment of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia

dAlbert Einstein Medical Center, Department of Urology, Elkins Park, Pennsylvania, USA

Correspondence to Philip H. Abbosh, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. E-mail:

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