This multicenter retrospective cohort study evaluated prognostic factors for recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in 1032 patients with pathological NMIBC (pTis/pTa/pT1 N0 R0) who underwent radical cystectomy at nine centers (2000–2015), with no perioperative therapy and a median follow-up of 45.2 months.
LVI (present in 3.8% of patients) was the strongest independent predictor of both recurrence (HR 2.37; 95% CI 1.29–4.38) and cancer-specific mortality (HR 2.59; 95% CI 1.31–5.10). LVI-positive patients had 10-year CSM of 35.3% vs. 13.7% in LVI-negative patients (p=0.002). Pathological stage (Tis/Ta/T1) was not an independent predictor of RFS (p=0.074). Age alone predicted OS (HR 1.06/year). Model discrimination was modest (optimism-corrected C-index 0.569).
- Retrospective design with potential unmeasured confounding, including lack of data on prior BCG exposure and number of prior recurrences. - LVI was assessed locally at each institution, introducing interobserver variability risk. - Small number of LVI-positive patients (n=39) limits subgroup statistical power; wide confidence intervals warrant external validation.
After radical cystectomy for NMIBC, check LVI status — LVI-positive pT1 patients have 5-year recurrence rates (~28.5%) approaching those of MIBC and should receive intensified surveillance in the first 24 months. Pathological stage alone should not guide post-cystectomy risk stratification; no treatment recommendations can yet be made based on LVI status.
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