POL Scientific / Bladder / Volume 11 / Issue 4 / DOI: 10.14440/bladder.2024.0031
RESEARCH ARTICLE

Molecular classification using Lund University algorithm and clinical correlations in muscle-invasive bladder cancer: Insights from a retrospective study

Davide Campobasso1* Simone Vezzini2 Sebastiano Buti3 Annalisa Patera1 Nicoletta Campanini4 Francesco Ziglioli1 Elena Thai4 Livia Ruffini5 Umberto Maestroni1 Enrico Maria Silini4
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1 Department of Urology, University Hospital of Parma, Parma, Emilia-Romagna, 43126 Italy
2 Pathology Unit, Department of Medical Sciences, University of Torino, AOU Città Della Salute E Della Scienza Di Torino, Turin, 10126 Italy
3 Unit of Medical Oncology, Department of Medicine and Surgery, University Hospital of Parma, Parma, Emilia-Romagna, 43126 Italy
4 Unit of Pathological Anatomy, Department of Medicine & Surgery, University Hospital of Parma, Parma, Emilia-Romagna, 43126 Italy
5 Nuclear Medicine Division, University Hospital of Parma, Parma, Emilia-Romagna, 43126 Italy
Bladder 2024 , 11(4), e21200019; https://doi.org/10.14440/bladder.2024.0031
Submitted: 17 August 2024 | Revised: 22 September 2024 | Accepted: 29 October 2024 | Published: 27 November 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Background: Muscle-invasive bladder cancer (MIBC) is universally classified as high-grade urothelial carcinoma, precluding the use of histological grading alone for prognostication. However, specific morphological features of MIBC may provide useful information to guide treatment decisions. In the last decade, there has been increasing interest in genetic profiling of MIBC. Objective: The aim of the study is to validate the use of Lund Classification in attributing phenotype to large series with extreme reliability and reproducibility compared to all histological sections in the clinical practice. Methods: We performed a molecular profiling study on a large, consecutive cohort of MIBC cases using a straightforward immunohistochemical algorithm aligned with the Lund Classification. Results: We evaluated 450 MIBC cases. In a subgroup of 103 patients, we assessed the concordance between transurethral resection of bladder tumor (TURBT) specimens and cystectomy on paired samples. Luminal tumor types showed a statistically significant association with the usual histotype, while basal and NULL types were more frequently associated with variant histotypes (p < 0.0001). A stromal lymphocytic infiltrate ≥10% was more commonly observed in basal types (p < 0.0001). Basal types also exhibited higher positive rates of human epidermal growth factor receptor-2 (HER2/neu) positivity, while luminal types were more likely to be positive for tumor suppressor protein p53. Luminal types have demonstrated longer survival compared to their basal and NULL counterparts. In the concordance analysis, tumor type assignment based on TURBT showed sensitivity, specificity, and both positive and negative predictive values of 100% for basal and NULL types. The predictive accuracy for luminal types on TURBT ranged between 89.5% and 98.2%. Conclusion: Our findings demonstrate the feasibility of applying the Lund Classification for molecular subtyping of MIBC in routine diagnostics. The consistency in tumor type assignment between TURBT and cystectomy samples further supports the clinical utility of this approach. Tumor types significantly influenced survival outcomes, underscoring its relevance in patient stratification and personalized treatment strategies.

Keywords
Bladder cancer
Immunohistochemistry
Lund taxonomy
Molecular subtype
Survival
Funding
None.
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Conflict of interest
The authors declare no conflict of interest.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific