To develop a data-driven risk-stratification model to identify high-risk patients following radical cystectomy (RC) for bladder cancer and propose a risk-adapted follow-up (FU) schedule.
We performed a retrospective analysis of an individual patient data registry comprising 3196 patients with clinical T stage (cT)2-T4 N0M0 bladder cancer who underwent RC at 16 European centres (1990-2024). All treatment decisions, including the use of neoadjuvant chemotherapy, adjuvant therapy, and the FU schedule, were made at the discretion of the treating physician in accordance with the patient's preference. A Classification and Regression Tree (CART) analysis, incorporating pathological T and N stages, lymphovascular invasion (LVI), and other features, was used to stratify patients into Low-Risk and High-Risk groups for recurrence. The primary endpoint was recurrence-free survival (RFS). We used a landmark analysis to evaluate the conditional risk of recurrence at 1, 2, 3, 4, and 5 years after RC.
At a median FU of 81.8 months, 891 patients recurred. CART analysis identified a High-Risk group (pathological T stage [pT]3-pT4, node-positive disease, or pT2 with LVI) with significantly worse 5-year RFS than the Low-Risk group (37.8% vs 76.2%; P < 0.001). This stratification was strongly prognostic for recurrence (hazard ratio [HR] 4.29; 95% confidence interval 3.63-5.00), cancer-specific survival (subdistribution HR 5.80), and overall survival (HR 3.04) (all P < 0.001). Landmark analysis confirmed that the elevated risk persisted up to 4 years; however, the conditional risk for event-free patients converged after 5 years (HR 1.37; P = 0.3).
This study establishes a simple, pathologically derived model (pT3-4/pN+/pT2 + LVI) that effectively stratifies post-RC patients, enabling a risk-adapted FU strategy. Prospective evaluation of this framework is required to confirm its clinical utility, safety, and cost-effectiveness.
BJU international. 2026 Mar 12 [Epub ahead of print]
Roberto Contieri, Alberto Martini, Marc Furrer, David D'Andrea, Francesco Claps, Markus von Deimling, Francesco Soria, Andrea Mari, Lorenzo Bianchi, Elena Tonin, Ronan Flippot, Jeremy Y C Teoh, Gauthier Marcq, Pierre-Emmanuel Desprez, Renate Pichler, Aleksander Ślusarczyk, José Daniel Subiela, Francesco Del Giudice, Valerio Santarelli, Angelo Porreca, Antonio Amodeo, Nicola Pavan, Alchiede Simonato, Pietro Scilipoti, Sisto Perdonà, Paolo Gontero, Bas Wg van Rhijn, Rodolfo Hurle, Marco Moschini, Benjamin Pradere, Laura S Mertens, European Association of Urology‐Young Academic Urologists (EAU‐YAU), Urothelial Carcinoma Working Group
Department of Urology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy., Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Urology Clinic, Department of Surgical Sciences, City of Health and Sciences at Molinette University Hospital, University of Turin, Turin, Italy., Unit of Oncologic Minimally Invasive Urology and Andrology Careggi Hospital, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Cancer Medicine, Gustave Roussy, Villejuif, France., Division of Urology, S H Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France., Department of Urology, Comprehensive Cancer Centre Innsbruck, Medical University of Innsbruck, Innsbruck, Austria., Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland., Department of Urology, Hospital Universitario Ramón y Cajal, IRYSIS, Universidad de Alcalá, Madrid, Spain., Department of Maternal Infant and Urologic Sciences, Sapienza University, Umberto I Polyclinic Hospital, Rome, Italy., Department of Urology, Humanitas Gavazzeni, Bergamo, Italy., Urology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, Italy., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Department of Urology, UroSUd, La Croix du Sud Hospital, Quint-Fonsegrives, France.