Comprehensive Analysis of Oncological Outcomes of Radical Cystectomy for Non-muscle Invasive Bladder Cancer

Abstract Owing to the rarity of radical cystectomy (RC) for non-muscle-invasive bladder cancer (NMIBC), information regarding oncological outcomes is limited. The aim was to conduct a comprehensive analysis of risk factors and survival outcomes following RC. This retrospective study included 435 patients who underwent RC for clinically diagnosed NMIBC at multiple institutions in Japan. The 5-year cancer-specific survival (CSS) rates were 97.4% for cTa, 93.3% for cTis, and 85.4% for cT1, respectively. Among 351 patients with cTa and cT1 disease, multivariate Cox proportional hazards analyses identified upstaging to ≥ pT2 or pN + disease as the most impactful risk factor associated with cancer-specific mortality (hazard ratio = 6.77; p < 0.01). Neither neoadjuvant chemotherapy nor lymph node dissection (LND) exhibited a survival benefit in terms of CSS in this cohort; however, LND was occasionally indicative of pN + disease, suggesting potential diagnostic value. The multivariate logistic regression analysis of preoperative variables identified tumour size (≥ 3 cm) as the lone risk factor associated with upstaging (odds ratio = 1.90; p = 0.03). Although the prediction of upstaging remains highly challenging, RC should not be delayed when clinically indicated, even for patients diagnosed with NMIBC, particularly in those with large tumours.