ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2023 April;75(2):180-7

DOI: 10.23736/S2724-6051.22.04953-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Accuracy of the European Association of Urology (EAU) NMIBC 2021 scoring model in predicting progression in a large cohort of HG T1 NMIBC patients treated with BCG

Roberto CONTIERI ^{1, 2}, Rodolfo HURLE ², Marco PACIOTTI ^{1, 2}, Paolo CASALE ², Alberto SAITA ², Francesco PORPIGLIA ³, Cristian FIORI ³, Biagio BARONE ⁴, Felice CROCETTO ⁴, Giuseppe LUCARELLI ⁵, Gian M. BUSETTO ⁶, Francesco DEL GIUDICE ⁷, Martina MAGGI ⁷, Francesco CANTIELLO ⁸, Rocco DAMIANO ⁸, Marco BORGHESI ⁹, Pierluigi BOVE ^{10, 11}, Riccardo BERTOLO ¹¹, Rocco PAPALIA ¹², Andrea MARI ¹³, Stefano LUZZAGO ¹⁴, Francesco A. MISTRETTA ¹⁴, Francesco SORIA ¹⁵, Paolo GONTERO ¹⁵, Michele MARCHIONI ¹⁶, Evelina LA CIVITA ¹⁷, Daniela TERRACCIANO ¹⁷, Giorgio I. RUSSO ¹⁸, Luigi SCHIPS ¹⁶, Sisto PERDONA ¹⁹, Vincenzo MIRONE ⁴, Octavian S. TATARU ²⁰, Gennaro MUSI ^{14, 21}, Mihai D. VARTOLOMEI ^{20, 22}, Riccardo AUTORINO ²³, Emanuele MONTANARI ²¹, Ottavio DE COBELLI ^{14, 24}, Matteo FERRO ¹⁴ ✉

¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; ² IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ³ Department of Urology, University of Turin, AOU San Luigi Gonzaga Hospital, Orbassano, Turin, Italy; ⁴ Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy; ⁵ Unit of Urology, Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; ⁶ Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; ⁷ Department of Urology, Sapienza University, Rome, Italy; ⁸ Department of Urology, Magna Graecia University, Catanzaro, Italy; ⁹ Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy; ¹⁰ Unit of Urology, Department of Surgery, Tor Vergata University, Rome, Italy; ¹¹ Department of Urology, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy; ¹² Department of Urology, Campus Bio-Medico University, Rome, Italy; ¹³ Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy; ¹⁴ Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy; ¹⁵ Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy; ¹⁶ Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, Chieti, Italy; ¹⁷ Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; ¹⁸ Department of Urology, University of Catania, Catania, Italy; ¹⁹ G. Pascale IRCCS Foudation, Naples, Italy; ²⁰ I.O.S.U.D., George Emil Palade University of Medicine and Pharmacy, Science and Technology, Targu Mures, Romania; ²¹ Department of Urology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; ²² Department of Urology, Medical University of Vienna, Vienna, Austria; ²³ Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA; ²⁴ Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy

BACKGROUND: Recently, the European Association of Urology Guidelines Panel updated the prognostic factor risk groups model for non-muscle-invasive bladder cancer (NMIBC) with the introduction of a new group of patients at very high risk (VHR). Furthermore, three additional clinical risk factors (i.e., age>70 years, multiple papillary tumors; tumor diameter >3 cm) were proposed. However, the new scoring model was created by analyzing data from patients who did not receive BCG intravesical therapy.
METHODS: This is a retrospective multicenter study analyzing data of 920 patients with HGT1 NMIBC that underwent ReTUR e following BCG intravesical therapy. Patients were stratified into risk groups according to the 2021 new EAU NMIBC prognostic factor risk groups model. This study aimed to identify variables related to disease progression in a large cohort of HGT1 NMIBC patients who underwent both Re-TURB and BCG intravesical immunotherapy.
RESULTS: Median follow-up was 51 months (IQR 41-75), according to EAU NMIBC 2021 scoring model 179 (19.5%) patients were at VHR. Progression-free survival at 5 years was 68.2% and 59.9% for the whole sample and the VHR group, respectively. At multivariable regression model size >3 cm, multifocal tumor, concomitant CIS and LVI were identified as independently associated with disease progression.
CONCLUSIONS: Although patients at VHR are more likely to experience disease progression during follow-up, the European Association of Urology (EAU) NMIBC 2021 scoring model appears to be suboptimal in patients who underwent ReTUR and intravesical BCG therapy.

KEY WORDS: Non-muscle invasive bladder cancer; Disease progression