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
Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
Cancers (Basel). 2023 Feb 1;15(3):934. 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.
pT1高级别（HG）尿路上皮癌（UC）且进展风险非常高的患者可能从即刻根治性膀胱切除术（RC）中获益，但这一选择仍存在争议。仍需要验证一种标准化方法，以评估经尿道膀胱肿瘤切除术（TURBT）标本中固有层（LP）浸润程度（具有公认的预后价值）。伦巴第肿瘤网络（ROL）系统在最近的回顾性研究中显示出对TURBT术后进展具有较高的预测价值。ROL系统应该在来自单一机构的大量原发性尿路上皮癌前瞻性系列研究中得到验证。2016年至2020年，我们对所有TURBT术后的pT1 HG UC患者采用了ROL。我们采用1.0毫米的阈值将肿瘤分层为ROL1和ROL2。共分析了222例pT1 HG UC。中位年龄为74岁，男性占多数（73.8%）。ROL在所有病例中均可行：91例为ROL1（41%），131例为ROL2（59%）。中位随访26.9个月（四分位间距13.8 - 40.6），我们记录到81例复发和40例进展。在单变量（HR 3.53；95%CI 1.56 - 7.99；P < 0.01）和多变量（HR 2.88；95%CI 1.24 - 6.66；P = 0.01）Cox回归分析中，ROL都是肿瘤进展的显著预测因素。根据Kaplan - Meier估计，ROL与无进展生存期（PFS，P = 0.0012）和复发无进展生存期（RFS，P = 0.0167）均相关。我们的结果证实了ROL在大量前瞻性系列研究中对进展具有很强的预测价值。我们鼓励应用ROL来报告LP浸润程度、对T1 HG UC进行亚分期以及完善泌尿外科决策的风险表。
