Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomy

PURPOSE: We sought to assess if precystectomy circulating tumor DNA (ctDNA) status predicts recurrence-free survival (RFS) and correlates with disease upstaging in patients with high-risk nonmuscle-invasive bladder cancer (NMIBC) undergoing radical cystectomy (RC). MATERIALS AND METHODS: We conducted a bicenter analysis of patients with high-risk NMIBC (cN0M0) who underwent RC between 2021 and 2023 and had prospective serial tumor-informed ctDNA analyses performed before and after RC. The molecular residual disease window was defined as the initial 90 days after RC. The primary end point RFS was analyzed with the Kaplan-Meier method. RESULTS: = .001). CONCLUSIONS: Detectable ctDNA for high-risk NMIBC pre-RC was associated with worse RFS, increased risk of pathological upstaging, and locally advanced disease with lymph node metastasis.