Predictors of pathological upstaging from TURBT at radical cystectomy: a single-centre retrospective analysis.

Abstract

Introduction & Objectives: Pathological upstaging between transurethral resection of bladder tumour (TURBT) at radical cystectomy (RC) worsens outcomes in urothelial carcinoma. Therefore, identifying predictors is essential to guide neoadjuvant therapy (NAC). Method(s): We retrospectively analysed 198 patients who underwent RC from February 2008 to February 2025 at a tertiary centre. Upstaging is defined as an increase in pathological T stage between the last TURBT and RC. Demographic, peri-operative and pathological variables were assessed with uni- and multivariable logistic regression. Result(s): Of the 191 patients reviewed, 21 cases were excluded as the TURBT specimen lacked muscularis propria and 7 for incomplete records, leaving 170 evaluable patients (Table 1). Upstaging was observed in 77 patients (45.3%), including 70 (41.2%) from organ-confined (OC) to non-organ confined (nOC) disease. At TURBT, 6 (3.5%) were Ta, 5 (2.9%) were Tis, 22 (12.9%) were T1, 132 (77.6%) were T2, 5 (2.9%) were T4. All T4 cases were due to prostatic invasion (Table 2). Univariable analysis showed lower odds of upstaging with NAC (OR 0.21, P = 0.007), overweight BMI (OR 0.42, P = 0.02), and being male (OR 0.38, P = 0.02) while lymphovascular invasion (LVI; OR 12.42, P < 0.001) and variant histology (OR: 5.91, P < 0.001) increased risk. In multivariable analysis, LVI (OR 19.8, P < 0.001) and variant histology (OR: 5.44, P = 0.015) remained independent predictors of upstaging. Conclusion(s): Our study confirms that pathological upstaging between TURBT and RC remains frequent, occurring in more than half of the patients. LVI and variant histology are independent risk factors for upstaging, consistent with the findings of the broader literature. Further prospective multicenter studies are needed to validate these findings and refine riskstratification tools.