Preoperative predictors of adverse pathological outcomes following radical cystectomy for muscle-invasive bladder cancer in a tertiary referral center.

Accurate preoperative identification of non-organ-confined disease in patients with muscle-invasive bladder cancer could guide patient selection for bladder-sparing strategies. We evaluated the association between available preoperative clinical variables linked to worse oncologic outcomes and pathologic upstaging (≥T3) at radical cystectomy in patients with muscle-invasive bladder cancer. We reviewed our cohort of patients with clinical T2 bladder cancer who underwent radical cystectomy at the Municipal Hospital of Cluj-Napoca, Romania, between 2017 and 2026. Univariable and multivariable logistic regression analyses were used to evaluate the association between preoperative clinical variables: tumor size > 3 cm at transurethral resection (TUR), chronic kidney disease (CKD), hydronephrosis, lymphovascular invasion (LVI), and non-organ-confined disease (≥pT3) at radical cystectomy. The final cohort consisted of 129 patients who underwent radical cystectomy and were included in the analysis. Lymphovascular invasion was independently associated with non-organ-confined disease on multivariable analysis across the entire cohort (OR = 6.99; 95% CI, 2.83-18.5;