Clinical Utility of lncRNAs in Urothelial Carcinoma of the Bladder: Diagnostics, Risk Stratification, and Treatment Guidance
Year: 2026
Type: article
Abstract: Urothelial carcinoma of the bladder remains challenging to assess in real time. Standard tools such as white-light cystoscopy and urine cytology are essential but have recognized limitations, particularly for carcinoma in situ and for repeated, long-term surveillance in non-muscle-invasive bladder cancer (NMIBC). Conventional risk models also show imperfect performance in contemporary practice, contributing to both overtreatment and delayed escalation in biologically aggressive disease. Long non-coding RNAs (lncRNAs) are emerging as attractive biomarkers because of their context-specific expression and their detectability in urine, including within extracellular vesicles/exosomes that protect RNA from degradation. Urinary lncRNAs show promise as non-invasive tools for hematuria triage and diagnostic support, risk stratification for recurrence and progression, and treatment guidance in selected settings. Repeatedly studied candidates include UCA1 and several exosomal/uEV-associated lncRNAs (e.g., TERC, SNHG16), while multi-lncRNA panels and combined strategies (including integration with established urine tests such as NMP22) may stabilize performance across biological and pre-analytical variability. Evidence also supports the concept of longitudinal “molecular response” monitoring using liquid-based lncRNA readouts, although truly predictive, treatment-interaction evidence remains limited. Across studies, performance is strongly influenced by the urine compartment analyzed (pellet/sediment, cell-free urine, or uEVs/exosomes) and by pre-analytical handling and normalization choices. lncRNA assays are unlikely to replace cystoscopy in the near term, but they have clear potential as decision-support tests that complement clinical risk assessment, cytology, and other urine-based platforms. This work synthesizes mechanistic and clinically annotated evidence on lncRNAs in bladder cancer, with an emphasis on urine-based and urinary extracellular vesicle (uEV)/exosomal assays. The search strategy covered publications from 1 January 2015 to 30 December 2025, with emphasis on most recent clinically relevant studies, and included mechanistic studies with functional validation, liquid biopsy/urine studies, and evidence syntheses.
DOI: 10.3390/ijms27219461
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7165792478