Prognostic value of apoptotic activity in muscle-invasive bladder cancer

Transitional cell carcinoma (TCC) of the bladder is a common malignancy worldwide that is associated with significant morbidity and mortality. The increasing number of patients diagnosed with urothelial cancer, year after year, and obvious limitations in standard diagnostic, therapeutic and prognostic approaches, created a strong interest in applying immunohistochemistry in the field of uropathology. A hallmark of bladder cancer is its variable prognosis. However, aggressive behavior is generally restricted to those tumors that are high grade, that have penetrated the lamina propria extensively and that are accompanied by carcinoma in situ either nearby to the tumor or at distant sites . Conventional clinical and pathologic parameters such as tumor grade, stage, size, multifocality, as well as vascular and lymphatic extension provide important diagnostic and prognostic information . The presence or absence of numerous histological parameters, such as thickness of urothelium, polarity, cytoplasmic clearing, nuclear size, nuclear crowding, nuclear chromatin distribution, nucleoli, mitoses, accompanying inflammation and neovascularity, undoubtedly, helps coming to the proper diagnosis for a given case 5, . Yet, they have a limited ability to predict the clinical outcome of many patients with bladder cancer and extensive efforts have been made to identify markers that could foretell recurrence and progression of the disease, development of metastases, response to treatment and patient survival . To become of clinical use, new prognostic markers must add some predictive capability beyond what current clinical and pathologic parameters offer . Prognostic mystery of muscle-invasive urothelial cancer