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NMIBC With Roger Li, MD

Urology

Dr. Li is a urologic oncologist at Moffitt Cancer Center whose practice focuses on the treatment of bladder, upper tract urothelial, and prostate cancers. His work has been instrumental in the development of clinical trials in the BCG-unresponsive space. He has authored over 100 peer-reviewed manuscripts and serves as reviewer for many international urologic journals.

Risk Stratification in BCG

Dear readers,

NMIBC is a clinically and molecularly heterogeneous disease. Risk stratification has traditionally been demarcated based on clinicopathologic characteristics, including tumor grade, stage, multifocality, size, and prior recurrences. In 2021, an updated EAU prognosticator incorporated the WHO 1973/2004 grading scales, as well as other clinical factors such as age and concomitant CIS to further stratify patients into four categories – low, intermediate, high, and very high risk. The UROMOL group has profiled over 800 tumors using a multi–omics approach. On transcriptomic analysis, four classes (1, 2a, 2b, and 3) were identified, reflecting tumor biology and disease aggressiveness.

In a follow-up study, the same group had identified whole-genome doubling in 15% of tumors using shallow whole-genome sequencing, which was associated with worse outcomes. In addition, pathology AI has also been applied to risk-stratify patients with HR NMIBC. In a multi-institutional study, an artificial-intelligence based histologic assay that extracted interpretable features from TURBT samples prior to BCG was able to identify patients at higher risk of recurrence, progression, and developing BCG-unresponsive disease.

Sincerely,
Roger Li, MD

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