Prospective Validation of the ROL System in Substaging pT1 High-Grade Urothelial Carcinoma: Results from a Mono-Institutional Confirmatory Analysis in BCG Treated Patients

• Published in: Cancers 2023-02, Vol.15 (3), p.934
• Main Authors: Valeri, Marina, Contieri, Roberto, Fasulo, Vittorio, Iuzzolino, Martina, Cieri, Miriam, Elefante, Grazia M, De Carlo, Camilla, Bressan, Alessandra, Saitta, Cesare, Gobbo, Andrea, Avolio, Pier Paolo, Dacrema, Valerio, Lazzeri, Massimo, Taverna, Gianluigi, Terracciano, Luigi M, Hurle, Rodolfo, Colombo, Piergiuseppe
• Format: Article
• Language: English
• Subjects: Bladder cancer; Care and treatment; Cystectomy; Decision making; Development and progression; Lamina propria; Medical prognosis; Methods; Patient outcomes; Tumors; Urinary tract cancer; Urothelial carcinoma
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15030934

Patients with pT1 high-grade (HG) urothelial carcinoma (UC) and a very high risk of progression might benefit from immediate radical cystectomy (RC), but this option remains controversial. Validation of a standardized method to evaluate the extent of lamina propria (LP) invasion (with recognized prognostic value) in transurethral resection (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. The ROL system was supposed to be validated on a large prospective series of primary urothelial carcinomas from a single institution. From 2016 to 2020, we adopted ROL for all patients with pT1 HG UC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1 HG UC were analyzed. The median age was 74 years, with a predominance of men (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%), and 131 were ROL2 (59%). At a median follow-up of 26.9 months (IQR 13.8-40.6), we registered 81 recurrences and 40 progressions. ROL was a significant predictor of tumor progression in both univariable (HR 3.53; CI 95% 1.56-7.99; < 0.01) and multivariable (HR 2.88; CI 95% 1.24-6.66; = 0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed a correlation with both PFS ( = 0.0012) and RFS ( = 0.0167). Our results confirmed the strong predictive value of ROL for progression in a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG UC, and improving risk tables for urological decision-making.