Prognostic Factors for Recurrence and Survival After Radical Cystectomy for Non–muscle-invasive Bladder Cancer: A Multicenter Analysis of 1032 Patients

BACKGROUND AND OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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. CONCLUSIONS: 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.