Accurate prediction of tumor recurrence in patients with superficial urothelial cell carcinoma (UCC) might result in a significant reduction of invasive follow-up cystoscopies. A recent study identified a panel of 26 genes from a large cDNA microarray analysis of bladder tumors that discriminated between early-and late-recurring patients with superficial Ta tumors (Dyrskjøt et al., Nat Genet 2003;33:90-6). We aimed to validate this panel of genes in 44 primary Ta UCCs (23 and 21 tumors from patients with short or prolonged recurrence-free periods, respectively), by real-time quantitative PCR. Statistical analysis showed marginal significant different mRNA expression levels between the 2 patient groups. To evaluate a supplementary effect of genes for the identification of patients with short or prolonged recurrence-free intervals, forward logistic regression analysis was applied. This revealed that a combination of the expression profiles of the genes HNRPK, LTB4DH and ANP32B resulted in the best performance, although the combination only marginally increased the predictive value of HNRPK alone. Comparing the receiver-operating-characteristic curves for HNRPK expression among patients with short or prolonged recurrence-free periods, revealed an area under the curve of 0.696 (95% CI, 0.537-0.855). Using the median HNRPK expression level as cut-off, a sensitivity of 69.6% and a specificity of 71.4% were obtained for the identification of patients with short or prolonged recurrence-free periods, respectively. In conclusion, we were not able to confirm the microarray gene expression pattern of the 26 genes shown by Dyrskjøt et al. The discovery of accurate recurrence predictive markers, therefore, remains a challenge. ' 2006 Wiley-Liss, Inc.Key words: recurrence; urothelial cell carcinoma; real-time quantitative PCR; microarray; validation Urothelial cell carcinoma (UCC) comprises up to 95% of human bladder cancer. It originates in the urothelium, the layer of cells lining the inner bladder wall. The larger part of patients with UCC is diagnosed with superficial tumors, pTNM stages Ta and T1, of which the depth of organ invasion is limited to the stromal mucosa. These tumors can be removed relatively easy by transurethral resection. Unfortunately, 70% of these patients experience recurrences after tumor removal and some will show progression towards muscle invasive disease. This necessitates frequent examination of the bladder by cystoscopy, which is invasive and represents a burden to the patient. The monitoring of these patients also includes those who will remain recurrence-free for several years or even for the rest of their lives. This generates a substantial number of unnecessary cystoscopies, which may be prevented by accurate prediction of tumor recurrence (or nonrecurrence) in patients with superficial UCC.The current standards for the estimation of the risk of recurrence are tumor grade, size and multiplicity. 1-3 Although these factors are relatively accurate in the group of patients with superficial UCC,...