Stenzl - Figure 18
Molecular Substratification
FIG. 18: To correct for the difficulties of tumor grading, we need to go to a molecular level in trying to substratify these T1 tumors. There are several methods of substratification, depending on different molecular aspects to show that a T1 tumor may show no progression at all or that it is actually either a pT2 or has the same features as a pT2 tumor, as muscle-invasive disease.[12] Molecular substratification may be very important; for example, the TCGA system [2] has substratification in cluster I and cluster II that will help to show whether this patient has a T1 tumor that can safely be treated with bladder preservation, or whether we should immediately remove the bladder in order to achieve the best outcome for the patient.
References
The Cancer Genome Atlas Research Network. Comprehensive molecular characterization of urothelial bladder carcinoma. Nature. 2014:507:315−22 nature.com/doifinder/10.1038/nature12965
Yun SJ, Kim SK, Kim WJ. How do we manage high-grade T1 bladder cancer? Conservative or aggressive therapy? Investig Clin Urol. 2016;57(Suppl 1):S44−51 https://doi.org/10.4111/icu.2016.57.S1.S44
