The Many Faces of Urothelial Carcinomas: An Update From Pathology to Clinical Approach and Challenges in Practice

KANKAYA D., BAĞLAN T.

Urology research and practice, vol.49, no.3, pp.147-161, 2023 (ESCI) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 49 Issue: 3
  • Publication Date: 2023
  • Doi Number: 10.5152/tud.2023.23023
  • Journal Name: Urology research and practice
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.147-161
  • Keywords: immunotherapy, PD-L1 genomic testing, targeted therapies, Biomarkers, bladder cancer, fibroblast growth factor receptor, histological subtypes, urothelial cancer, INVASIVE BLADDER-CANCER, LYMPHOEPITHELIOMA-LIKE CARCINOMA, URINARY-BLADDER, CLINICOPATHOLOGICAL ANALYSIS, GLANDULAR DIFFERENTIATION, NEOADJUVANT CHEMOTHERAPY, HISTOLOGICAL VARIANTS, RADICAL CYSTECTOMY, INTRINSIC SUBTYPES, POOR-PROGNOSIS
  • Ankara University Affiliated: Yes

Abstract

Urothelial carcinoma is a heterogeneous disease with histomorphological and genomic variations throughout the same tumor or between tumors from different patients. It has been shown that most of these histologic and genetic differences have prognostic significance and may have a guiding role in determining the appropriate treatment choice for the patient. Therefore, it is crucial for both the pathologist and the clinician to be conscious of these variations and to consider them in patient man agement. Recently, a consensus molecular classification has been developed and cat egorized urothelial carcinomas into 6 subclasses. These molecular subclasses seem to be associated with prognosis and/or response to certain therapeutic approaches like chemotherapy or immune checkpoint inhibitory therapy; however, it has not yet been sufficiently validated and has some limitations for routine application. As is well known, there are therapeutic limitations in locally advanced or metastatic urothelial carcino mas, especially those inappropriate for standard therapy with platinum-based chemo therapy regimens. Emerging new therapeutic approaches and testing for appropriate patient selection for those are discussed in this article