836 Background: Bladder cancer staging has historically focused solely on the depth of invasion, and the impact of tumor size remains unclear. This study aimed to assess the role of tumor size on postoperative complications, recurrence-free survival (RFS), and overall survival (OS) in muscle-invasive bladder cancer. Methods: We reviewed our IRB-approved radical cystectomy database for patients who underwent radical cystectomy between 2004 and 2024. Patients with non-muscle invasive disease or (y)pT0 were excluded. Tumors were categorized into four quartiles based final pathological size. Multivariate cox regression analyses were used to assess predictors of OS and RFS. Results: 1,168 patients were included in the analysis. Median tumor sizes were 1.2 cm, 2.5 cm, 3.8 cm, and 6.0 cm in quartiles 1 (smallest) to 4 (largest), respectively. Patients with larger tumors were more likely to have extravesical or lymph node positive disease, variant histology, and lymphovascular invasion (Table 1). The overall 30-day complication rates (Q1: 57.3%, Q2: 53.7%, Q3: 58.4%, Q4: 61.1%) and 90-day complication rates (Q1: 69.8%, Q2: 68.2%, Q3: 68.8%, and Q4: 71.9%) were comparable (p = 0.479, 0.785, respectively). All 90-day complication subtypes and 30- and 90-day readmission rates were comparable between quartiles. Multivariate analysis showed that after adjusting for confounders including age, baseline comorbidities, pathological staging, and adverse pathological features, Q3 had higher risks of recurrence (HR: 1.5, 95% CI: 1.1 – 2.0, p = 0.005) and death (HR: 1.4, 95% CI: 1.1 - 1.8, p = 0.011) compared to Q1, while Q4 showed even greater risks of recurrence (HR: 2.1, 95% CI: 1.5 – 2.7, p (y)pT2N0) 77 (26.1%) 113 (34.6%) 85 (30.5%) 102 (38.2%) Lymph node positive (pN+) 81 (27.5%) 121 (37.0%) 127 (45.5%) 120 (44.9%) Histologic subtype (variant histology) 67 (22.7%) 99 (30.3%) 84 (30.1%) 116 (43.5%) < 0.001 Positive lymphovascular invasion 105 (35.6%) 164 (50.2%) 165 (59.1%) 154 (57.7%) < 0.001 Adjuvant Chemotherapy 39 (13.2%) 72 (22.0%) 58 (20.8%) 45 (16.9%) 0.021 </
Zahir et al. (2026) studied this question.