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Background <p>T1 non-muscle-invasive bladder cancer (NMIBC) represents a biologically aggressive subgroup with substantial heterogeneity in recurrence and progression risk. Current clinicopathological risk stratification tools lack sufficient precision to identify patients at the highest risk of progression to muscle-invasive bladder cancer (MIBC).</p> Objective <p>To characterize transcriptomic differences between T1 and &lt; T1 (Ta/Tis) NMIBC and to explore the association of fibroblast activation protein-α (<i>FAP</i>) gene expression with disease progression.</p> Methods <p>Transcriptomic profiling was performed on formalin-fixed paraffin-embedded (FFPE) tumor tissue from 66 patients with primary, treatment-naïve NMIBC and 5 patients with T2 disease (included for exploratory comparisons). Analyses included differential gene expression, gene set enrichment analysis (GSEA), molecular subtyping, immune cell deconvolution, and evaluation of <i>FAP</i> expression in relation to recurrence and progression. External validation of <i>FAP</i> was conducted in three independent NMIBC cohorts.</p> Results <p>T1 tumors demonstrated a distinct transcriptomic profile compared with &lt; T1 tumors, characterized by enrichment of cell cycle-related and metabolic pathways and a higher prevalence of aggressive molecular subtypes. Despite these molecular differences, no statistically significant differences in recurrence-free, progression-free, cancer-specific, and overall survival were observed, likely reflecting limited event numbers. Among recurrent tumors, early recurrences (≤ 24&#xa0;months) were associated with epithelial-mesenchymal transition signatures. <i>FAP</i> expression increased with tumor stage (<i>p</i> = 0.0005) and was associated with progression (<i>p</i> = 0.002) and mortality (<i>p</i> = 0.01). Patients with tumors in the highest quartile of <i>FAP</i> expression had worse progression-free survival. This association was consistently observed in three external NMIBC cohorts.</p> Conclusions <p>T1 NMIBC exhibits distinct transcriptomic features suggestive of increased biological aggressiveness. Elevated <i>FAP</i> expression is reproducibly associated with progression risk across multiple cohorts, supporting its potential role as a biomarker of aggressive disease. Given the limited number of progression events, these findings should be considered hypothesis-generating and warrant prospective validation before clinical implementation.</p> Graphical Abstract <p></p>

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Transcriptomic profiling across stages of non-muscle-invasive bladder cancer identifies fibroblast activation protein-alpha as a stromal biomarker associated with progression

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月15日

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  • Murat Akand,
  • J. Alberto Nakauma-González,
  • Tatjana Jatsenko,
  • Thomas Gevaert,
  • Loïc Baekelandt,
  • Marcella Baldewijns,
  • Joris Robert Vermeesch,
  • Frank Van der Aa,
  • Steven Joniau

摘要

Background

T1 non-muscle-invasive bladder cancer (NMIBC) represents a biologically aggressive subgroup with substantial heterogeneity in recurrence and progression risk. Current clinicopathological risk stratification tools lack sufficient precision to identify patients at the highest risk of progression to muscle-invasive bladder cancer (MIBC).

Objective

To characterize transcriptomic differences between T1 and < T1 (Ta/Tis) NMIBC and to explore the association of fibroblast activation protein-α (FAP) gene expression with disease progression.

Methods

Transcriptomic profiling was performed on formalin-fixed paraffin-embedded (FFPE) tumor tissue from 66 patients with primary, treatment-naïve NMIBC and 5 patients with T2 disease (included for exploratory comparisons). Analyses included differential gene expression, gene set enrichment analysis (GSEA), molecular subtyping, immune cell deconvolution, and evaluation of FAP expression in relation to recurrence and progression. External validation of FAP was conducted in three independent NMIBC cohorts.

Results

T1 tumors demonstrated a distinct transcriptomic profile compared with < T1 tumors, characterized by enrichment of cell cycle-related and metabolic pathways and a higher prevalence of aggressive molecular subtypes. Despite these molecular differences, no statistically significant differences in recurrence-free, progression-free, cancer-specific, and overall survival were observed, likely reflecting limited event numbers. Among recurrent tumors, early recurrences (≤ 24 months) were associated with epithelial-mesenchymal transition signatures. FAP expression increased with tumor stage (p = 0.0005) and was associated with progression (p = 0.002) and mortality (p = 0.01). Patients with tumors in the highest quartile of FAP expression had worse progression-free survival. This association was consistently observed in three external NMIBC cohorts.

Conclusions

T1 NMIBC exhibits distinct transcriptomic features suggestive of increased biological aggressiveness. Elevated FAP expression is reproducibly associated with progression risk across multiple cohorts, supporting its potential role as a biomarker of aggressive disease. Given the limited number of progression events, these findings should be considered hypothesis-generating and warrant prospective validation before clinical implementation.

Graphical Abstract