The value of histopathological prognostic factors in superficial bladder cancer: Do we need more?

The primary indicators of outcome for patients with superficial bladder cancer (determination of risk for recurrence and progression) continue to be based on clinical and histopathologic parameters and include such factors as recurrence rate, multiplicity, size, grade, and stage. While these prognostic factors can separate patients with superficial bladder cancer into high and low risk groups, the predictability for individual patients remains imprecise. Furthermore, indicators of recurrence do not necessarily provide useful information regarding the risk of progression (increase in stage). While cytology is commonly used to detect recurrent disease, its accuracy is dependent on tumor grade and the experience of the cytopathologist. Ploidy and morphometric analysis can provide additional information and be an important adjunct to cytology. There is need for new markers of outcome particularly in determining the risk of progression.