Diagnostic stage discordance and survival in T2 bladder cancer: rethinking the clinical behavior of progressive disease

OpenAlex · English

Progression from non–muscle-invasive bladder cancer (NMIBC) to muscle-invasive bladder cancer (MIBC) remains a major clinical challenge, particularly at the T2 stage. This study aimed to evaluate pathological stage concordance and survival outcomes between patients with primary and progressive T2 MIBC following radical cystectomy (RC). A total of 106 patients with clinical T2-stage bladder cancer who underwent RC were retrospectively analyzed. Patients were categorized as primary or progressive T2 based on their initial transurethral resection of bladder tumor (TUR-BT) pathology. Demographic, histopathological, and survival variables were compared between the two groups using appropriate statistical tests. Kaplan–Meier and univariable Cox regression analysis were performed to assess survival and prognostic factors. In the progressive group, T2 disease was identified on a subsequent TUR-BT, with a median interval of 3 (2–10) months. No significant difference was observed in stage concordance between TUR-BT and RC pathology between the primary and progressive T2 groups ( p = 0.525). The mean number of positive lymph nodes was higher in the primary group ( p = 0.012). Upper urinary tract recurrence was significantly more frequent in the progressive group ( p = 0.007). No significant difference was observed in distant metastasis rates between the groups. Overall survival was also comparable (46.0 vs. 31.0 months, log-rank p = 0.329). Pathological stage at RC was the only factor significantly associated with overall survival. Progressive T2 MIBC was not associated with significant differences in pathological stage concordance, distant metastasis rates, or overall survival compared with primary T2 disease. These findings suggest that progressive disease may not represent a more aggressive biological phenotype. Nevertheless, pathological stage discordance remained common in both groups, highlighting the limitations of clinical staging. Accurate stage assessment and timely radical cystectomy remain critical for the optimal management of T2 MIBC.