Preoperative predictors of adverse pathological outcomes following radical cystectomy for muscle-invasive bladder cancer in a tertiary referral center.

Accurate preoperative identification of non-organ-confined disease in patients with muscle-invasive bladder cancer could guide patient selection for bladder-sparing strategies. We evaluated the association between available preoperative clinical variables linked to worse oncologic outcomes and pathologic upstaging (≥T3) at radical cystectomy in patients with muscle-invasive bladder cancer. We reviewed our cohort of patients with clinical T2 bladder cancer who underwent radical cystectomy at the Municipal Hospital of Cluj-Napoca, Romania, between 2017 and 2026. Univariable and multivariable logistic regression analyses were used to evaluate the association between preoperative clinical variables: tumor size > 3 cm at transurethral resection (TUR), chronic kidney disease (CKD), hydronephrosis, lymphovascular invasion (LVI), and non-organ-confined disease (≥pT3) at radical cystectomy. The final cohort consisted of 129 patients who underwent radical cystectomy and were included in the analysis. Lymphovascular invasion was independently associated with non-organ-confined disease on multivariable analysis across the entire cohort (OR = 6.99; 95% CI, 2.83-18.5; P < 0.001), among patients who received neoadjuvant chemotherapy (OR = 10.5; 95% CI, 2.62-53.1; P = 0.002), and among those who did not (OR = 5.13; 95% CI, 1.41-21.2; P = 0.017). Hydronephrosis was associated with non-organ-confined disease on univariable analysis but did not remain significant on multivariable analysis in the overall cohort (OR = 1.77; 95% CI, 0.71-4.36; P = 0.2). Chronic kidney disease and tumor size greater than 3 cm were associated with non-organ-confined disease on univariable but not multivariable analysis. Lymphovascular invasion was the most consistent independent predictor of pathologic upstaging at radical cystectomy. Further research in larger cohorts is needed to validate these findings.