Impact of Molecular Subtypes in Muscle-invasive Bladder Cancer on Predicting Response and Survival after Neoadjuvant Chemotherapy

Research output: Contribution to journalArticle


Background: An early report on the molecular subtyping of muscle-invasive bladder cancer (MIBC) by gene expression suggested that response to neoadjuvant chemotherapy (NAC) varies by subtype. Objective: To investigate the ability of molecular subtypes to predict pathological downstaging and survival after NAC. Design, setting, and participants: Whole transcriptome profiling was performed on pre-NAC transurethral resection specimens from 343 patients with MIBC. Samples were classified according to four published molecular subtyping methods. We developed a single-sample genomic subtyping classifier (GSC) to predict consensus subtypes (claudin-low, basal, luminal-infiltrated and luminal) with highest clinical impact in the context of NAC. Overall survival (OS) according to subtype was analyzed and compared with OS in 476 non-NAC cases (published datasets). Intervention: Gene expression analysis was used to assign subtypes. Outcome measurements and statistical analysis: Receiver-operating characteristics were used to determine the accuracy of GSC. The effect of GSC on survival was estimated by Cox proportional hazard regression models. Results and limitations: The models generated subtype calls in expected ratios with high concordance across subtyping methods. GSC was able to predict four consensus molecular subtypes with high accuracy (73%), and clinical significance of the predicted consensus subtypes could be validated in independent NAC and non-NAC datasets. Luminal tumors had the best OS with and without NAC. Claudin-low tumors were associated with poor OS irrespective of treatment regimen. Basal tumors showed the most improvement in OS with NAC compared with surgery alone. The main limitations of our study are its retrospective design and comparison across datasets. Conclusions: Molecular subtyping may have an impact on patient benefit to NAC. If validated in additional studies, our results suggest that patients with basal tumors should be prioritized for NAC. We discovered the first single-sample classifier to subtype MIBC, which may be suitable for integration into routine clinical practice. Patient summary: Different molecular subtypes can be identified in muscle-invasive bladder cancer. Although cisplatin-based neoadjuvant chemotherapy improves patient outcomes, we identified that the benefit is highest in patients with basal tumors. Our newly discovered classifier can identify these molecular subtypes in a single patient and could be integrated into routine clinical practice after further validation. Molecular subtypes in muscle-invasive bladder cancer appear have an impact on patient response to neoadjuvant chemotherapy (NAC); namely, patients with basal tumors showed the most benefit from NAC and should be prioritized for NAC. Moreover, these subtypes can be identified in a single sample by our discovered classifier.


  • Roland Seiler
  • Hussam Al Deen Ashab
  • Nicholas Erho
  • Bas W G van Rhijn
  • Brian Winters
  • James J Douglas
  • Kim E M van Kessel
  • Elisabeth E. Fransen van de Putte
  • Matthew Sommerlad
  • Natalie Q. Wang
  • Voleak Choeurng
  • Ewan A. Gibb
  • Beatrix Palmer-Aronsten
  • Lucia L. Lam
  • Christine Buerki
  • Elai Davicioni
  • Jordan Kardos
  • Katherine A. Hoadley
  • Seth P. Lerner
  • David J. McConkey
  • Woonyoung Choi
  • William Y. Kim
  • Bernhard Kiss
  • George N. Thalmann
  • Tilman Todenhöfer
  • Simon J. Crabb
  • Scott North
  • Ellen C. Zwarthoff
  • Joost L. Boormans
  • Jonathan Wright
  • Marc Dall'Era
  • Michiel S. van der Heijden
  • Peter C. Black
External organisations
  • University of Bern
  • GenomeDx Biosciences
  • Antoni Van Leeuwenhoek Hospital
  • Washington University School of Medicine
  • University Hospital Southampton
  • Erasmus University Medical Center
  • University of North Carolina
  • Baylor College of Medicine
  • University of Texas
  • University of British Columbia
  • University of Alberta
  • University of California, Davis
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology
  • Cancer and Oncology


  • Bladder cancer, Molecular subtypes, Neoadjuvant chemotherapy, Response prediction
Original languageEnglish
Pages (from-to)544-554
JournalEuropean Urology
Issue number4
Early online date2017
Publication statusPublished - 2017
Publication categoryResearch