Contemporary Trends and Predictors Associated with Adverse Pathological Upstaging Among Non-Metastatic Localized Clinical T2 Muscle-Invasive Bladder Cancers Undergoing Radical Cystectomy: Outcomes from a Single Tertiary Centre in the United Kingdom

In this article, we reviewed 275 cT2N0M0 bladder cancer patients who underwent radical cystectomy at our institution from 2014 to 2024. The aim was to assess the preoperative and intraoperative predictors of pathological upstaging (>pT2 or >pN+). We found that high grade carcinomas at TURBT and variant histology were independent risk factors for upstaging, while multidisciplinary management and neoadjuvant chemotherapy were found to be protective. In addition, clinical lymph node staging with FDG-PET imaging was found to yield a higher risk of pN+ at final pathological analysis. An accurate preoperative staging and a precise understanding of risk factors for pathological upstaging are fundamental in the era of bladder-sparing strategies.