Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration

Lonati, Chiara; Baumeister, Philipp; Afferi, Luca; Mari, Andrea; Krajewski, Wojciech; Azizi, S Ausim; Hendricksen, Kees; Martini, Alberto; Necchi, Andrea; Montorsi, Francesco; Briganti, Alberto; Colombo, R.; Tafuri, Alessandro; Antonelli, Alessandro; Cerruto, Maria Angela; Rouprêt, Morgan; Masson-Lecomte, A.; Laukhtina, Ekaterina; D’Andrea, David; Shariat, Shahrokh F.; Soria, Francesco; Marra, Giancarlo; Contieri, Roberto; Hurle, Rodolfo; Valiquette, Anne Sophie; Mir, Maria Carmen; Zamboni, Stefania; Simeone, Claudio; Klatte, Tobias; Teoh, Jeremy Yuen‐Chun; Yoshida, Soichiro; Fujii, Yasuhisa; Carando, Roberto; Schulz, Gerald Bastian; Mordasini, Livio; Mattei, Agostino; Moschini, Marco

doi:10.1016/j.euf.2021.07.015

Cited by 15 publications

(6 citation statements)

References 28 publications

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“…Over the last decades, some clinical, pathological and molecular features have shown a reliable negative predictive role and are currently used in the risk stratification of these patients [3][4][5][6][7][8][9][10][11][12][13][14]. Among the investigated histological characteristics, the value of assessing LP invasion has been extensively debated.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, RC could be an effective treatment in selected pT1 HG, while it might represent a potential overtreatment for others. Over the past decades, many efforts have been made to improve risk stratification and identify those patients who may benefit from immediate radical treatment; some features have demonstrated a solid predictive role and are currently employed [3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Prospective Validation of the ROL System in Substaging Pt1 High-Grade Bladder Cancer: Results from a Prospective Mono-Institutional Confirmatory Analysis in BCG Treated Patients

Valeri¹,

Contieri²,

Fasulo³

et al. 2023

Preprint

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Patients with pT1 high-grade (HG) bladder cancer (BC) 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 resections (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. Our aim was to validate ROL system on a large mono-institutional prospective series of primary urothelial carcinomas. From 2016 to 2020, we adopted ROL for all patients with pT1 HG BC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1HGBC were analyzed. Median age was 74 years, with male predominance (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%) and 131 ROL2 (59%). At a median follow up of 26.9 months (IQR 13.8-40.6), we registered 80 recurrences and 40 progressions. ROL was a significant predictor of tumor progression at both univariable (HR 3.53; CI 95% 1.56 – 7.99; p&lt;0.01) and multivariable (HR 2.90; CI 95% 1.25 – 6.75; p=0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed correlation with both PFS (p=0.0012) and RFS (p=0.0167). Our results confirmed the strong predictive value of ROL for progression on a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG BC, and improving risk tables for urological decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prospective Validation of the ROL System in Substaging Pt1 High-Grade Bladder Cancer: Results from a Prospective Mono-Institutional Confirmatory Analysis in BCG Treated Patients

Valeri¹,

Contieri²,

Fasulo³

et al. 2023

Preprint

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“…In our recent retrospective multicentre study including 119 T1 high-grade MPBC patients, we aimed to compare survival outcomes after immediate radical cystectomy and conservative management with Bacillus Calmette–Guérin (BCG) [21 ▪▪ ]. Within a median follow-up of 35 months [interquartile range (IQR): 19–64], we did not find any significant difference in 5-year cancer-specific mortality and overall mortality according to the therapeutic strategy (35 versus 13%, and 35 versus 24%, respectively).…”

Section: Evidence Synthesismentioning

confidence: 99%

Micropapillary bladder cancer: an evolving biology

Lonati

Simeone

Suardi

et al. 2022

Current Opinion in Urology

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Purpose of reviewTo summarize a comprehensive overview of more recent evidence on micropapillary bladder cancer (MPBC), focusing on actual incidence, clinical features, therapeutic strategies, and prognosis.Recent findingsMPBC generally exhibits an aggressive behaviour compared with pure urothelial carcinoma (pUC) with advances in tumour stage and nodal and distant spread at diagnosis. Due to its rarity and presence of only small sample size and retrospective studies, no consensus currently exists regarding the most effective therapeutic strategy to be performed among nonmuscle-invasive (conservative treatment versus immediate radical cystectomy) and muscle-invasive MPBC (neoadjuvant therapy versus upfront radical cystectomy versus adjuvant chemotherapy).SummaryThe incidence of MPBC is recently increased according to latter literature, ranging from 2.9 to 7.6% of all bladder cancer. Despite its aggressive behaviour at time of presentation, more recent evidence fails to demonstrate a significant association between MPBC and worse outcomes compared with pUC when adjusted for clinical and pathological features. According to latter evidence, MPBC pathological response to NAC appears to be unsatisfactory compared with pUC patients while neoadjuvant immunotherapy with Pembrolizumab may represent an effective treatment among MPBC patients, based on PD-L1 and TMB expression.

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“…Based on the published literature, patients with micropapillary, plasmacytoid, sarcomatoid, or neuroendocrine variants should be classified as very high-risk for progression to MIBC and, therefore, counseled for early radical treatments at the time of diagnosis. The presence of pure micropapillary histological variant has been associated with disease progression (HR 2.50), especially when in combination with LVI [15 ▪ ]. Conversely, patients with neither pure micropapillary histology nor LVI may be initially treated with intravesical BCG with satisfactory results.…”

Section: Evidence Synthesismentioning

confidence: 99%

Clinical and biological markers for risk-stratification of T1 high-grade non-muscle invasive bladder cancer

Soria

Dutto²

2022

Current Opinion in Urology

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Purpose of reviewTo summarize the prognostic and predictive role of current clinical and biological markers in patients with T1 high-grade (T1HG) nonmuscle invasive bladder cancer (NMIBC).Recent findingsClassical clinico-pathologic markers such as age, tumor size, focality, and location as well as the presence of concomitant carcinoma in situ, lymphovascular invasion, and histological variants at the time of transurethral resection (TUR) should be used in the risk-stratification of T1HG to improve patients’ selection for early aggressive treatment. pathological T1 substaging has shown to predict disease progression and response to intravesical therapy, and should therefore be reported in the pathological assessment to improve clinical decision-making. Urinary inducible cytokines measured at different time points during Bacillus Calmette-Guerin therapy may be used to predict response to treatment, while urinary mRNA-based biomarkers may be of value to select patients for repeated TUR (reTUR). The advent of genomic classification in NMIBC and that of immune markers may improve current risk-stratification tools and pave the way toward personalized treatment.SummaryThe role of clinico-pathologic variables in the risk-stratification of T1HG NMIBC remains unaltered, despite insufficient. Urinary biomarkers and tissue-based immune markers hold the promise to revolutionize the paradigm of risk-stratification due to their potential role in predicting response to intravesical and systemic immunotherapy. However, to date, none of the investigated biomarkers is used in clinical practice to risk-stratify T1HG patients due to the lack of external and/or prospective validations.

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Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration

Cited by 15 publications

References 28 publications

Prospective Validation of the ROL System in Substaging Pt1 High-Grade Bladder Cancer: Results from a Prospective Mono-Institutional Confirmatory Analysis in BCG Treated Patients

Prospective Validation of the ROL System in Substaging Pt1 High-Grade Bladder Cancer: Results from a Prospective Mono-Institutional Confirmatory Analysis in BCG Treated Patients

Micropapillary bladder cancer: an evolving biology

Clinical and biological markers for risk-stratification of T1 high-grade non-muscle invasive bladder cancer

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