To compare the perioperative outcomes and long-term survivors between localized (organ-confined cT2N0M0) and locally advanced (cT3-4 and/or cN1-3,M0) bladder cancer in patients undergoing radical cystectomy and lymphadenectomy.
We conducted a retrospective observational cohort study including 364 consecutive patients who underwent open RC with urinary diversion at a high-volume tertiary referral center between July 2016 and November 2024. Patients were stratified according to pathological stage into localized disease (pT0-T2N0) and locally advanced disease (pT3-T4 and/or N1). Perioperative outcomes were evaluated using multivariable regression models. Overall survival (OS) was analyzed with Cox regression and Kaplan-Meier estimates. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed using Fine-Gray competing-risks models. Propensity score matching (PSM) was performed as a sensitivity analysis.
Among 364 patients, 203 had localized and 161 had locally advanced BCa. Locally advanced disease was associated with greater intraoperative blood loss (β 230 ml, 95% CI 89.9-370.3) and longer operative time (β 16.5 min, 95% CI 2.6-30.3), but postoperative complication rates were similar between groups. With a median follow-up of 54.9 months in localized and 36.4 months in locally advanced BCa, locally advanced disease was associated with significantly worse oncologic outcomes. Multivariable analyses confirmed higher risks of overall mortality (HR 3.40, 95% CI 2.40-4.81), recurrence (sHR 5.12, 95% CI 3.45-7.59), and cancer-specific mortality (sHR 2.26, 95% CI 1.43-3.59). Results were consistent after PSM.
This study showed that, compared with localized disease, RC for locally advanced BCa was associated with similar 30-day mortality and major complication rates, but worse oncological outcomes. These findings support the perioperative feasibility of surgery in selected patients with locally advanced disease while underscoring their persistently poorer cancer prognosis.
International urology and nephrology. 2026 Apr 09 [Epub ahead of print]
Pierluigi Russo, Nazario Foschi, Nicolò Lentini, Francesco Pio Bizzarri, Giuseppe Maioriello, Mauro Ragonese, Chiara Ciccarese, Roberto Iacovelli, Giuseppe Palermo, Marco Campetella, Carlo Gandi, Domenico Nigro, Francesco Rossi, Domenico Varacalli, Savio Domenico Pandolfo, Or Schubert, Filippo Gavi, Daniele Fettucciari, Maria Chiara Sighinolfi, Marco Racioppi, Emilio Sacco, Bernardo Rocco
Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy., Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. ., Department of Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Department of Urology, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy., Department of Urology, University of L'Aquila, 67100, L'Aquila, Italy.