Association between time from diagnosis to radical cystectomy and oncologic outcomes in muscle-invasive urothelial carcinoma of the bladder

Authors

  • Phillip Kim Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Sumedh Kaul Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Aaron Fleishman Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Agustin Perez-Londono Beth Israel Deaconess Medical Center
  • Simon Kim Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO
  • Joaquim Bellmunt Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
  • Nima Aghdam Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA
  • Aria F. Olumi Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Peter Chang Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Andrew Wagner Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
  • Boris Gershman

DOI:

https://doi.org/10.5489/cuaj.9576

Keywords:

bladder cancer, radical cystectomy, delay, pathologic upstaging, overall survival

Abstract

Introduction: A delay beyond 12 weeks from diagnosis to radical cystectomy (RC) is considered to impart worse oncologic outcomes for patients with muscle-invasive bladder cancer (MIBC); however, no randomized clinical trials have examined this question. We therefore emulated a hypothetical target clinical trial using contemporary data to evaluate the association between time from diagnosis to RC and oncologic outcomes.

Methods: We conducted observational analyses using the National Cancer Database from 2006−2015 to emulate a hypothetical target trial in adults aged 40−79 years with incident cT2−4 N0 M0 urothelial carcinoma of the bladder, treated with RC from 4−18 weeks after diagnosis. We evaluated the association of late RC with pathologic upstaging at RC and overall survival (OS) and conducted exploratory analyses evaluating the association of time to RC with each outcome modeled flexibly.

Results: A total of 3747 patients were included, of which 2992 underwent early RC. Median followup was 32.2 months. In adjusted analyses, late RC was not associated with an increased risk of pathologic upstaging compared to early RC. In addition, there was no statistically significant difference in adjusted OS for late and early RC, respectively. Similar findings were observed across categories of cT stage, age, Charlson index, and gender.

Conclusions: In observational analyses designed to emulate a hypothetical target trial of early vs. late RC, the timing of RC was not associated with a statistically significant increase in pathologic upstaging or a difference in OS when performed from 4−18 weeks after diagnosis. These results suggest the need to re-examine the traditional recommendations for timing of RC following diagnosis.

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Published

2026-07-21

How to Cite

Kim, P., Kaul, S., Fleishman, A., Perez-Londono, A., Kim, S., Bellmunt, J., … Gershman, B. (2026). Association between time from diagnosis to radical cystectomy and oncologic outcomes in muscle-invasive urothelial carcinoma of the bladder. Canadian Urological Association Journal, 20(11). https://doi.org/10.5489/cuaj.9576

Issue

Vol. 20 No. 11 (2026): CUAJ November

Section

Original Research

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