Outcomes after radical cystectomy (RC) for non-muscle-invasive bladder cancer (NMIBC) are generally favorable, but a subset experiences recurrence and cancer-specific mortality (CSM). Tools to identify high-risk patients remain limited. This study aimed to identify predictors of recurrence and cancer-specific and overall mortality in pathological NMIBC treated with RC.
Multicenter retrospective cohort of 1032 patients with pTis/pTa/pT1 N0 R0 disease who underwent RC (2000-2015) at nine centers. No patient received perioperative therapy.
Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using Cox and competing-risks regression. Discrimination assessed by Harrell's C-index.
Median follow-up 45.2 mo. Lymphovascular invasion (LVI), present in 39 patients (3.8%), was independently associated with RFS (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.29-4.38; p = 0.006) and CSS (HR, 2.59; 95% CI, 1.31-5.10; p = 0.006). Pathological stage was not associated with RFS (p = 0.074). Age predicted OS (HR 1.06; p < 0.001). LVI-positive patients had higher 10-yr CSM (35.3% vs 13.7%; p = 0.002). Discrimination was modest (C-index 0.59). Limitations include retrospective design and low LVI prevalence.
In patients undergoing RC for pathological NMIBC, LVI identifies a small subgroup at increased risk of recurrence and CSM, while pathological stage adds little. These findings support LVI-guided surveillance and trial enrichment, but no treatment recommendations can be drawn.
European urology oncology. 2026 Jun 20 [Epub ahead of print]
Mehdi Kardoust Parizi, David D'Andrea, Benjamin Pradere, Jeremy Yuen-Chun Teoh, Piotr Chłosta, Pierre I Karakiewicz, Ekaterina Laukhtina, Marco Moschini, Mohammad Abufaraj, Dmitry Enikeev, Leonardo Oliveira Reis, Katherina Oberneder, Stephan Brönimann, Marcin Miszczyk, Shahrokh F Shariat
Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: ., Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, France., S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Jagiellonian University Medical College, Kraków, Poland., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada., Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan., Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., UroScience and Department of Surgery (Urology), School of Medical Sciences, University of Campinas, Unicamp, São Paulo, Brazil; Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil., Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland., Department of Urology, Austrian Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medicine, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, Texas, USA; College of Medical Health Technologies, Al-Turath University, Mansour, Baghdad, Iraq; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.