MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING

Abstract

You have accessJournal of UrologyCME1 May 2022MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING Marina Valeri, Roberto Contieri, Vittorio Fasulo, Miriam Cieri, Grazia M. Elefante, Massimo Lazzeri, Gianluigi Taverna, Luigi M. Terracciano, Rodolfo Hurle, and Piergiuseppe Colombo Marina ValeriMarina Valeri More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Miriam CieriMiriam Cieri More articles by this author , Grazia M. ElefanteGrazia M. Elefante More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Gianluigi TavernaGianluigi Taverna More articles by this author , Luigi M. TerraccianoLuigi M. Terracciano More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , and Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of T1 high-grade (HG) bladder cancer (BC) patients is still a challenging issue in urological practice. Depth and amount of lamina propria (LP) tumor invasion is a key prognostic variable. Compared to other substaging methods, the Rete Oncologica Lombarda (ROL) system - simply based on a 1-mm threshold- showed a high predictive value for tumor progression after transurethral resections of the bladder (TUR) in recent retrospective studies. Our aim was to validate ROL system on a large monoistitutional prospective series of primary urothelial carcinomas from TUR. METHODS: From 2013 to 2020, we prospectively maintained a database of pT1HG BC patients with available clinicopathologic data. Using ROL system for T1 substaging, we adopted a cut-off of 1 mm (diameter of a high-power field, HPF, objective 20x) to stratify tumors in ROL1 and ROL2, corresponding to invasive focus or multiple foci extending together for <1 HPF and for >1 HPF, respectively. Univariate and multivariate Cox proportional hazard models were employed to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier (KM) survival estimates were used to investigate ROL’s predictive role on progression free survival (PFS) and recurrence free survival (RFS). RESULTS: A total of 229 confirmed T1HG BC entered the prospective study. Mean age was 73 yr and most patients were male (74.7%); 70 tumors were multifocal (30.57%), 33 cases had divergent differentiation (14.4%), associated carcinoma in situ (CIS) and lymphovascular invasion (LVI) occurred in 32 (14%) and 20 (9%) cases, respectively. ROL was feasible in all but one case (99.6%): 94 cases were ROL1 (41%) and 134 ROL2 (59%). All patients completed the BCG induction course and at least 1 or 2 maintenance courses. At a median follow up of 23 months (IQR 12.33-38.5), 59 patients had recurrence (25.76%) and 37 patients had progression (16%). ROL was a significant predictor of progression in univariate Cox regression analysis (OR= 3.58, 95% CI, 1.50-8.56; p=0.004), confirmed by the multivariate analysis (OR= 2.95, 95% CI, 1.11-7.87; p=0.03). In KM estimates for PFS and RFS, ROL showed a significant correlation with progression (p <0.01), while no significance was reached for recurrence (p >0.05). CONCLUSIONS: Our results confirmed the strong predictive role of ROL for progression on a large prospective series. We foster the application of ROL system for substaging T1HG BC, a simple and feasible method that might identify high risk patients and drive urological decision making. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e391 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marina Valeri More articles by this author Roberto Contieri More articles by this author Vittorio Fasulo More articles by this author Miriam Cieri More articles by this author Grazia M. Elefante More articles by this author Massimo Lazzeri More articles by this author Gianluigi Taverna More articles by this author Luigi M. Terracciano More articles by this author Rodolfo Hurle More articles by this author Piergiuseppe Colombo More articles by this author Expand All Advertisement PDF DownloadLoading ...