Introduction: Absence of residual cancer in radical cystectomy (RC) specimens is a well-known positive prognostic factor for non-muscle and muscle-invasive bladder cancer (NMIBC and MIBC) in patients with or without neoadjuvant chemotherapy (NAC). Understanding the clinical and pathological features associated with a final pT0 status can provide valuable prognostic insights, serve as a surrogate marker for survival outcomes, and help identify candidates suitable for bladder-sparing strategies.Methods: Temporal trends and clinical/demographic characteristics across clinically high-/very-high-risk NMIBC or MIBC RC patients from 2009 to 2024 were explored. Subsequently, RC pT0 patients were propensity score-matched (PSM, 1:1 ratio) with the >pT0 population based on age-adjusted CCI and preoperative clinical stage (cTis-T1 vs. cT2). Multivariable regression modelling was applied to explore predictors of pT0 status stratified according to clinical NMIBC or MIBC status.Results: A total of 655 RCs performed with curative intent were included (43% for MIBC, 57% for NMIBC). Of these, 117 were pT0 at final pathological assessment (68 NMIBC and 49 MIBC). Subsequently, 228 PSM patients (114 pT0 vs. 114 >pT0) were extracted from the original cohort and stratified according to preoperative clinical stage (MIBC vs. NMIBC). In multivariable analysis, male gender was associated with an increased likelihood of pT0 status in the NMIBC cohort (adjusted odds ratio [aOR] 2.89, 95% CI 1.13–7.90). Conversely, BCG failure and concomitant CIS independently reduced the chances of achieving pT0 status (aOR: 0.40, 95% CI 0.19–0.99; aOR: 0.16, 95% CI 0.03–0.97). For MIBC patients, as expected, NAC more than doubled the chances of achieving pT0 status (aOR: 2.20, 95% CI 1.01–6.82). On the other hand, the concomitant presence of CIS reduced the likelihood of pT0 achievement (aOR 0.22, 95% CI, 0.06–0.80). In both cohorts, the presence of variant histology (VH) demonstrated a negative association with pT0 achievement; however, the estimated effect did not reach statistical significance (p= 0.09 andp= 0.08).Conclusions: Our findings suggest potentially raising the threshold for RC consideration in high-risk or very-high-risk NMIBC patients with a favourable risk profile. MIBC patients without additional risk factors (CIS and VH) are more likely to achieve a tumour-free status, particularly when adequately receiving NAC.
引言：根治性膀胱切除术（RC）标本中无残留癌，是无论是否接受新辅助化疗（NAC）的非肌层浸润性膀胱癌（NMIBC）和肌层浸润性膀胱癌（MIBC）患者已知的积极预后因素。了解与最终病理分期pT0状态相关的临床和病理特征，可提供有价值的预后信息，作为生存结果的替代标志物，并有助于识别适合膀胱保留策略的患者。 方法：本研究探讨了2009年至2024年间临床高危/极高危NMIBC或MIBC RC患者的时间趋势及临床/人口学特征。随后，根据年龄校正CCI和术前临床分期（cTis-T1 vs. cT2），将RC pT0患者与>pT0人群进行倾向评分匹配（PSM，1:1比例）。应用多变量回归模型，探索根据临床NMIBC或MIBC状态分层的pT0状态的预测因素。 结果：共纳入655例以治愈为目的进行的RC（43%为MIBC，57%为NMIBC）。其中，117例在最终病理评估中为pT0（68例NMIBC，49例MIBC）。随后，从原始队列中提取228例PSM患者（114例pT0 vs. 114例>pT0），并根据术前临床分期（MIBC vs. NMIBC）进行分层。在多变量分析中，在NMIBC队列中，男性与pT0状态可能性增加相关（校正比值比[aOR] 2.89，95% CI 1.13–7.90）。相反，BCG治疗失败和伴随原位癌（CIS）独立降低了达到pT0状态的机会（aOR：0.40，95% CI 0.19–0.99；aOR：0.16，95% CI 0.03–0.97）。对于MIBC患者，正如预期，NAC使达到pT0状态的机会增加了一倍以上（aOR：2.20，95% CI 1.01–6.82）。另一方面，伴随CIS的存在降低了达到pT0的可能性（aOR 0.22，95% CI 0.06–0.80）。在两个队列中，变异组织学（VH）的存在均显示出与达到pT0状态呈负相关；然而，估计效应未达到统计学显著性（p=0.09和p=0.08）。 结论：我们的研究结果表明，对于具有良好风险特征的高危或极高危NMIBC患者，可能提高考虑RC的阈值。没有额外风险因素（CIS和VH）的MIBC患者更有可能达到无肿瘤状态，尤其是在充分接受NAC的情况下。
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