Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Introduction: We sought to describe the incidence, risk factors, and survival outcomes associated with pathologic upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). Methods: We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as >= pT(2) or pathologic node positive (pN+) at final pathology analysis from clinical = 3; 55% vs 44%, p=0.04), and had higher rate of preoperative hydronephrosis (26% vs 10%, p<0.01). They were more likely to have positive surgical margins (10% vs 3%, p=0.01), recurrences (28% vs 9%, p<0.01), and to receive adjuvant/salvage treatment (26% vs 3%, p<0.01). On multivariate analysis, upstaging was associated with older age (odds ratio [OR] 1.04; confidence interval [CI] 1.01-1.07, p<0.01), cT(1)vs cTis (OR 4.25; CI 1.57-11.48, p<0.01), cT(1)vs cTa (OR 2.92; CI 1.40-6.06, p<0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p<0.01). Upstaged patients had worse 5-year RFS (53% vs 85%, log rank p<0.01), DSS (66% vs 93%, log rank p<0.01), and OS (49% vs 74%, log rank p<0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p=0.17). Conclusion: Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT(1) disease and hydronephrosis were more likely to upstage.

Automated summary

The study showed that a significant proportion of NMIBC patients experienced pathologic upstaging to MIBC after RARC, with older age, cT(1) disease, and hydronephrosis being associated with a higher likelihood of upstaging. Upstaged patients had worse survival outcomes.