Conclusion

The studies summarized here and others indicate that expression profiling provides a molecular means of identifying clinically important tumor subtypes and molecular targets not identified using standard methods. Gene expression profiling could define, at the molecular level, the individual clinical and histopathological phenotypes of bladder tumors. Reports using different microarray platforms and analyzing specific cancer subgroups are warranted to find consensus on subclasses and signatures of the disease with diagnostic and predictive utility (Fig. 3). Creation of international tumor banks represents an option that might facilitate interactive research among different laboratories. Further efforts using in vitro and in vivo models are warranted to characterize functionally the pathways by which many of the targets already identified to be involved in tumorigenesis or bladder cancer progression. The utility of the application of microarrays has not estimated yet many clinical issues in bladder cancer. Identification of Ta-Tl-IS subtypes within superficial disease and patients more likely to develop positive lymph nodes or distant metastases are critical subclassification questions to be answered. Another area that will provide critical targets for clinical intervention is that of pharmacogenomics. In the near future, gene profiling will provide effective means to predict the response against specific therapeutic regimes based on the molecular signatures of the tumors associated with their chemosensitivity or resistance to anticancer drugs. Moreover, the discovery of molecular pathways altered in cancer progression as well as the identification of molecule-susceptible targets would lead to the development of novel alternative therapies. The combined information revealed by these studies also allows the identification of new molecular determinants involved in the progression of the disease with clinical diagnostic or predictive utility. The classical tumor marker concept of an individual biological determinant will be substituted by the use of cluster of genes as predictive classifiers. These genetic signatures will allow a better chance of cure by opting for individualized therapies and development of bio-markers of diagnostic and predictive value for patients with bladder cancer.

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