[Pathological Risk Stratification of Non-Muscle-Invasive and Muscle-Invasive Urothelial Carcinoma for Optimal Therapeutic Decision-Making].

Abstract

The treatment of urothelial carcinoma is undergoing rapid change. For both non-muscle-invasive urothelial carcinoma (NMIBC) and muscle-invasive urothelial carcinoma (MIBC), state-of-the-art substances are being tested in various therapy concepts to reduce the risk of recurrence and progression and to increase bladder preservation rates (particularly in muscle-invasive urothelial carcinoma and BCG-refractory high/very high-risk pT1 carcinoma). Antibody-drug conjugates such as enfortumab vedotin, as well as new immunotherapies, play a key role in this context. However, it remains controversial according to which criteria patients with NMIBC should undergo early cystectomy and patients with MIBC should receive bladder-preserving therapy. This paper attempts to discuss the current treatment standards in this controversial context and to address possible histopathological and molecular stratification tools that could improve or guide this selection in the future.