Association of initial transurethral resection staging on survival in radical cystectomy patients

Abstract

Purpose: Muscle-invasive bladder cancer (MIBC) is highly aggressive and presents complex treatment challenges. This study aimed to determine if the stage found during the initial transurethral resection of bladder tumor (TURBT) significantly impacts the prognosis of patients undergoing subsequent radical cystectomy (RC). Materials and Methods: We retrospectively analyzed a multi-institutional database of 3,258 RC patients treated between January 2010 and December 2019, with confirmed survival data. The analysis included 68 variables such as baseline characteristics, initial and highest TURBT pathology, and final pathology. Patients were categorized into four groups based on initial T stage: pTa, pT1, pT2, and Tis (carcinoma in situ). Results: The mean follow-up was 46.6 +/- 38.7 months. There were no significant differences in demographic variables between the groups. Overall survival (OS) rates differed significantly across the four groups (p=0.017). Crucially, the Tis group demonstrated the most favorable long-term outcomes, with an OS rate over 60% at 150 months. The initial pTa, pT1, and pT2 groups did not show significant OS differences among themselves. Conclusions: The initial TURBT stage is associated with the prognosis of patients undergoing RC for bladder cancer. Patients with carcinoma in situ (Tis) is associated with more favorable outcomes from earlier cystectomy, leading to markedly improved long-term survival. For patients with more advanced initial stages (pT1, pT2), however, final pathology and lymph node status are more predictive of survival than the initial TURBT findings.