Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials.

BACKGROUND:Radical cystectomy with pelvic lymph node dissection (PLND) remains the standard treatment for muscle-invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) improves survival, and recent immunochemotherapy trials have reported complete pathological responses in up to 60% of patients, increasing interest in bladder-sparing strategies. However, the ability to accurately identify patients without residual pelvic lymph node metastases after NAC remains limited. OBJECTIVE:To evaluate the association between pathological response in the bladder and pelvic lymph node status after NAC in patients with MIBC undergoing radical cystectomy (RC) and PLND. DESIGN, SETTING, AND PARTICIPANTS:This retrospective, multi-institutional cohort study included 751 patients with MIBC treated with NAC followed by RC and PLND between 2000 and 2021 across 26 institutions. INTERVENTION:Neoadjuvant chemotherapy followed by RC and PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was residual lymph node involvement (ypN+). Multivariable logistic regression was used to identify factors associated with ypN+. RESULTS AND LIMITATIONS:Overall, 175 patients (23%) achieved a complete pathological response in the bladder (ypT0), 102 (14%) were downstaged to non-muscle-invasive disease (ypTa/ypTis/ypT1), and 185 (25%) had residual lymph node involvement. On multivariable analysis, cN+ disease before NAC was associated with higher odds of ypN+ (OR 1.97, 95% CI 1.32-2.94), whereas ypT0 (OR 0.11, 95% CI 0.05-0.21) and ypTa/ypTis/ypT1 (OR 0.24, 95% CI 0.12-0.47) were associated with lower odds of ypN+. Notably, 5% of ypT0 and 10% of downstaged patients harboured residual lymph node metastases. Limitations include potential selection bias and centre-level variability in surgical and pathological assessment, which may affect the generalizability of the findings. CONCLUSIONS:Current clinical and radiological variables cannot reliably exclude residual pelvic lymph node disease, even in patients achieving ypT0-1. Novel imaging techniques and liquid biomarkers require validation before bladder-sparing approaches can be safely expanded.

β-Catenin is a dual function protein with roles in cell cohesion and as a critical intracellular signal transducer in the Wnt signaling pathway. Cytoplasmic and nuclear translocation of the β-Catenin protein results in an increased transcription of cancer promoting genes. To study the prevalence and the potential role of aberrant β-Catenin staining patterns, more than 2,700 bladder tumors were analyzed by immunohistochemistry (IHC) in a tissue microarray format. The cohort included 636 patients with radical cystectomy for muscle-invasive disease (pT2-4) for which follow-up data were available. In normal urothelium, β-Catenin staining was always strong and largely limited to the cell membranes. A comparable staining pattern was also seen in the overwhelming majority of non-invasive pTa tumors, especially in case of low-grade neoplasms. Aberrant β-Catenin staining patterns were observed in 20.3% of tumors and included unequivocal (2.8%) and equivocal nuclear/cytoplasmic staining (10.6%), complete loss of β-Catenin staining (1.5%), and reduced β-Catenin staining (1+, 5.4%). β-Catenin staining was heterogeneous in 20.8%. All aberrant β-Catenin staining patterns were associated with invasive tumor growth (p = < 0.0001–0.0006), but unrelated to survival of patients with pT2-4 cancers. A complete loss of membranous β-Catenin staining was linked to UICC stage (p = 0.0106) and within pT2-4 tumors, to high pN (p = 0.0014) and pT p = 0.0100). Associations also occurred between heterogeneity and nodal metastasis (p = 0.0207), equivocal nuclear/cytoplasmic staining and high tumor grade (p = 0.0465), and low expression level and advanced pT (p = < 0.0001). It is concluded that clear-cut alterations of β-Catenin expression such as a nuclear and cytoplasmic translocation and a complete expression loss occur rarely in urothelial carcinomas of the urinary bladder. Patients with nuclear expression of β-Catenin in their tumors might benefit from specific therapies once Wnt pathway inhibitors should become safe and efficient.

The tumor suppressor gene PTEN plays an important role in many cancer types. Mechanism of PTEN inactivation includes gene mutations and deletions. In this large multi-center study, we analyzed the impact of PTEN deletions on tumor aggressiveness, patient prognosis, and p53 and p16 alterations, especially in muscle-invasive urothelial bladder carcinomas to expand the results from our previous study on 686 pTa to pT4 urothelial bladder carcinomas. The PTEN copy number status was analyzed by fluorescence in situ hybridization (FISH) on more than 2700 urothelial bladder carcinomas in a tissue microarray format. PTEN deletion data were compared with clinico-pathological parameters in pTa and pT2-4 carcinomas and clinical outcomes in pT2-4 carcinomas, immunohistochemical p16 and p53 expression, and TP53 copy number status measured by FISH from previous studies. PTEN deletions occurred in 18.8% of 1854 analyzable carcinomas, including 17.6% heterozygous and 1.2% homozygous deleted tumors. The PTEN deletion rate increased markedly from pTaG2 low-grade (3.1%), to pTaG2 high-grade (4.5%) and pTaG3 (20.7%, p  < 0.0001) carcinomas, and was 23.8% in pT2-4 carcinomas ( p  < 0.0001 for pTa vs. pT2-4). In pT2-4 cancers, PTEN deletions were unrelated to histopathological parameters of tumor aggressiveness and patient outcome. PTEN deletions were significantly associated with parameters of p53 alterations and p16 overexpression. It is concluded that PTEN deletions accumulate with grade progression in non-invasive urothelial carcinomas of the urinary bladder. The absence of a prognostic role of PTEN deletions in pT2-4 urothelial carcinomas is in line with our notorious inability to predict the clinical course of these tumors by only one morphological or molecular feature.

BACKGROUND:Divergent differentiation (DD) and histological subtypes (HS) represent rare but clinically meaningful forms of upper tract urothelial carcinoma (UTUC), but their prognostic impact remains incompletely understood. We assessed the incidence, clinicopathological characteristics, and oncologic outcomes associated with DD-HS in a large multi-institutional cohort of patients undergoing radical nephroureterectomy (RNU) for non-metastatic UTUC. METHODS:We retrospectively analyzed 3,441 patients treated between 1985 and 2022 across 22 institutions. Tumors were classified as pure urothelial carcinoma (PUC), DD, and HS. Clinicopathological features and survival outcomes-including recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS)-were compared using the Kaplan-Meier estimator, stratified by pathological stage (organ-confined [OC: ≤pT2N0-Nx] vs. non-organ-confined [NOC: ≥pT3 or ≥pN1]) and multivariable Cox regression. RESULTS:DD-HS were present in 201 patients (5.8%), with DD comprising 139 (69%). Compared to PUC, DD-HS were associated with more advanced T/N stages, higher rates of lymphovascular invasion (40% vs. 20%), multifocality (35% vs. 27%), and concomitant carcinoma in situ (21% vs. 14%) (all P < 0.05). While outcomes for DD were similar to stage-matched PUC, HS showed significantly worse stage-matched RFS (OC: 38% vs. 83%; NOC: 25% vs. 46%) and OS (OC: 44% vs. 75%; all P < 0.01), and remained independently associated with poorer outcomes on multivariable analyses. Limitations include the retrospective design and lack of centralized pathology review. CONCLUSIONS:UTUC with DD-HS represents a biologically heterogeneous population with distinct oncologic outcomes compared with PUC. Further investigation into subtype-specific tumor biology and rigorous pathological characterization is warranted to better define the clinical relevance of individual histological entities and to guide future treatment strategies.

Urinary bladder cancer is the tenth most common malignancy worldwide and represents a major global health burden [...].

BACKGROUND AND OBJECTIVE:Ureteral stents are used to protect the ureteroenteric anastomosis during radical cystectomy and urinary diversion (RCUD); however, complications can occur from its use. The objective of this study was to perform a systematic review of perioperative stenting strategies and postoperative outcomes in patients undergoing RCUD for bladder cancer. METHODS:This review was published via PROSPERO (CRD42024558468) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. Prospective comparative (randomised and nonrandomised) studies published until June 2024 were included. All outcomes were included in the analysis. Risk of bias assessments were undertaken. KEY FINDINGS AND LIMITATIONS:The search yielded 1516 abstracts. Six prospective comparative studies (740 patients) were included. Although there was some evidence of reduced postoperative complications (urinary leak, ureteroileal stricture, postoperative obstruction, length of stay, and readmission within 30 d) with the omission of stents during RCUD, this did not reach statistical significance (n = 3). No differences in postoperative complications were identified between internal and external stenting (n = 2). Early stent removal (5 d) was associated with reduced urinary tract infections and hospital readmission (n = 1). There was a high/serious risk of bias with all studies. CONCLUSIONS AND CLINICAL IMPLICATIONS:The role of perioperative stenting during RCUD in preventing ureteroenteric complications remains equivocal and does not favour one approach over another. Until further results from on-going randomised controlled trials become available, urologists should carefully consider the indications to place a ureteric stent and its retention time after RCUD.

Abstract Purpose We aimed to assess the impact of GATA3 binding protein (GATA3) gene copy number alterations on tumor aggressiveness, patient prognosis, and GATA3 protein expression in a large urothelial bladder cancer cohort. Methods A tissue microarray containing over 2,700 urothelial bladder cancers (pTa-pT4) was analyzed retrospectively using dual-labeling fluorescence in-situ hybridization (FISH) with probes for GATA3 (10p14) and centromere 10. GATA3 copy number gains were categorized as GATA3 elevation (ratio GATA3/centromere ≥ 2/≤4), low-level amplification (ratio > 4/≤12), and high-level amplification (ratio > 12) and deletions were divided between homozygous and heterozygous. Results GATA3 copy number gain was detected in 9.9% of 2,213 interpretable tumors, including 2.0% with GATA3 elevation, 3.2% with low-level amplification, and 4.7% with high-level amplification. The frequency of high-level amplification increased from pTa G2 low (0%) to pTa G3 tumors (12% [CI 0.07;0.21]; p < 0.0001 pTa G2 low vs. pTaG2 high) but decreased in advanced-stage carcinomas pT2-4 with 5.4% [CI 0.07;0.21] (p < 0.0001, pTa vs. pT2-4). In muscle-invasive carcinomas, GATA3 amplification was not linked to tumor aggressiveness or patient survival. Overall, no homozygous GATA3 deletion was detected and heterozygous GATA3 deletion was only observed in 1.1%; of 1,432 pT2-4 tumors without any association to cancer progression. While GATA3 copy number was significantly correlated with GATA3 expression (p < 0.0001), the relationship was not strong. Only 2.3% of GATA3-negative cancers had a deletion, and 42.1% of strong GATA3-expressing cancers exhibited high-level amplification. Conclusion High-level GATA3 amplification is common in urothelial bladder cancer and correlates with grade progression in pTa tumors, while GATA3 deletion is rare. Neither amplification nor deletion appears to be the primary driver of GATA3 expression dysregulation. Clinical trial number Not applicable.

Background Loss of chromosome Y (LOY) has recently been proposed to be associated with cancer aggressiveness, altered T-cell function, and poor prognosis in bladder carcinomas. Methods Chromosome Y was analyzed using fluorescence in-situ hybridization on a tissue microarray containing 2,071 urothelial carcinomas of the urinary bladder from male patients, including 487 patients who had undergone cystectomy for muscle-invasive disease and for whom follow-up data were available. Data on tumor microenvironment were obtained from a previous study. Results LOY was found in 26.0% of 1,704 analyzable cancers. In non-invasive cancers, LOY frequency was comparable in pTa G2 (22.8%) and pTa G3 (24.1%, p = 0.8036) carcinomas and slightly increased from pTa to pT2 - 4 carcinomas (23.1% for pTa and 27.2% for pT2 - 4) but these differences were not significant ( p = 0.0794). In muscle-invasive cancers, LOY frequency slightly increased from pT2 (25.5%) to pT4 cancers (33.0%), but this association was not significant ( p = 0.1814). Among pT2 - 4 cancers, LOY was associated with venous invasion ( p = 0.0010) but unrelated to pT, pN, and L-status, as well as to overall, recurrence-free, and cancer-specific survival. Muscle-invasive urothelial carcinomas with and without LOY did not show significant differences in the number of CD8 positive lymphocytes, fraction of CD8 positive intraepithelial lymphocytes, number of macrophages and dendritic cells, and fraction of T helper and T regulatory cells. Conclusion The lack of a clear association of LOY with histopathological parameters of cancer aggressiveness, patient prognosis, and parameters describing the tumor microenvironment strongly argues against the driving role of LOY in bladder cancer progression and cancer-associated immune reactions.

Background and objective:Preoperative anemia is common in patients undergoing radical cystectomy for bladder cancer, but its prevalence and impact on outcomes remain poorly characterized across different health care settings. This study aims to assess the prevalence of preoperative anemia, evaluate its current management practices, and determine its association with postoperative and oncological outcomes in patients undergoing radical cystectomy. Methods:We retrospectively analyzed 4886 patients with nonmetastatic bladder cancer who underwent radical cystectomy across 28 centers in 13 countries. Multivariable regression models identified the predictors of preoperative hemoglobin levels and postoperative blood transfusions. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards regression analyses. Key findings and limitations:Preoperative anemia was present in 44% of women and 48% of men. Among anemic patients, 73% received no blood management interventions. Higher hemoglobin levels before transurethral resection of a bladder tumor correlated with higher levels before cystectomy and fewer postoperative blood transfusions (odds ratio: 0.98, 95% confidence interval [CI]: 0.97-0.99, p < 0.001). Higher preoperative hemoglobin levels were associated with lower 90-d mortality rates (hazard ratio: 0.98, 95% CI: 0.97-0.99, p < 0.001) and independently predicted reduced all-cause mortality, cancer-specific mortality, and disease relapse. Conclusions and clinical implications:Preoperative anemia is prevalent and undertreated in patients undergoing radical cystectomy, and is independently associated with adverse perioperative and oncological outcomes. This highlights the need for further research regarding the potential benefits of implementing systematic preoperative anemia management. Patient summary:This study found that low blood counts before bladder removal surgery are common, often untreated, and linked to worse outcomes. Early treatment of low blood counts before surgery could improve results for patients.

OBJECTIVE:To evaluate the impact of discordant histological diagnoses between transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) on cancer-specific mortality (CSM) in patients with bladder cancer (BCa). PATIENTS AND METHODS:We relied on a multi-institutional database collecting data of patients with BCa who underwent TURBT and subsequent RC from nine centres between 2000 and 2023. We tested concordance rates between TURBT and RC in detecting urothelial carcinoma of the urinary bladder (UCUB) as well as non-UCUB hystological subtypes, using RC as the reference standard. Concordance was defined as the agreement between a specific histological subtype identified both at TURBT and RC and evaluated according to Cohen's kappa coefficient. Subsequently, survival analyses consisted of Kaplan-Meier plots and multivariable Cox regression (MCR) models addressing CSM according to concordance between TURBT and RC (namely, concordant vs discordant). RESULTS:Overall, 3160 patients were identified. Of these, 2762 (87%) harboured UCUB and 398 (13%) non-UCUB at TURBT vs 2481 (79%) UCUB and 679 (21%) non-UCUB at RC. There were 683 (21.6%) patients with a discordant diagnosis between TURBT and RC. The overall concordance in detecting non-UCUB subtypes was defined as fair concordance (Cohen's kappa coefficient: 0.32). In MCR models, a discordant diagnosis exhibited higher CSM relative to those with a concordant diagnosis (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1-1.6; P = 0.002). In a sensitivity analysis including patients with UCUB not exposed to neoadjuvant chemotherapy, this survival disadvantage was even higher (HR 1.5, 95% CI 1.1-1.7; P = 0.04). CONCLUSIONS:A discordant histopathological diagnosis between TURBT and RC is associated with higher CSM rates, particularly in cases initially misdiagnosed as UCUB. However, we also observed a moderate concordance between TURBT and RC in identifying non-UCUB subtypes.

BACKGROUND AND OBJECTIVE:Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery may affect overall survival. This study aims to evaluate Rx rates, identify predictive factors, and assess their impact on overall survival compared to negative margins (R0). METHODS:We conducted a retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020). Patients underwent partial or radical nephrectomy. The primary outcome was Rx at final pathology. Multivariable logistic regression and Cox proportional hazard regression were employed to identify predictors and assess survival impact. KEY FINDINGS AND LIMITATIONS:Rx was observed in 0.62% of cases. Partial nephrectomy, laparoscopic approach, and major vein involvement were associated with increased odds of Rx. Rx was linked to worse overall survival (adjusted Hazard Ratio 1.38; 95% CI, 1.22-1.57; P < .01). Limitations include selection bias and data quality variations. CONCLUSIONS AND CLINICAL IMPLICATIONS:Our study indicates that Rx should not be considered equivalent to R0 resection status, as it is associated with worse overall survival in RCC. These findings may aid in the postoperative risk assessment of RCC patients and guide clinical decision-making.

Objective:The gene lysine demethylase 6A (KDM6A) located on chromosome Xp11 often shows truncating mutations in urothelial carcinoma. Mutations resulting in protein expression loss can be detected by immunohistochemistry (IHC). Methods:A tissue microarray with >2,500 bladder tumors was analyzed by IHC. 78 cancers were sequenced for KDM6A. Results:KDM6A expression loss decreased from 36% of 345 pTaG2 low-grade to 23% of 152 pTaG2 high-grade and 18.5% of 92 pTaG3 tumors (p=0.0004) but not further in pT2-4 cancers (17.2-21.9%). KDM6A staining was unrelated to pT, pN, grade, and overall survival (p>0.1894) in 636 patients with pT2-4 cancers. KDM6A loss was more common in male (22.2%) than in female patients (15.4%; p=0.0067), and in tumors from males with Y-chromosome loss (36.1%) than without Y-loss (16.3%; p<0.0001). A KDM6A loss occurred in all 15 male and in 17 (74%) of 23 female patients with a truncating KDM6A mutation, but only 15 (75%) of 20 male and 17 (81%) of 21 female patients with KDM6A expression loss had a truncating mutation. Conclusions:KDM6A expression loss is frequent in urothelial carcinoma and mostly due to truncating mutations. KDM6A IHC may be a useful tool for the distinction of neoplastic from non-neoplastic urothelial cells in follow-up examinations of patients with KDM6A deficient cancers.

BACKGROUND AND OBJECTIVE:This publication represents a summary of the updated 2025 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). The aim is to provide practical recommendations on the clinical management of MMIBC with a focus on diagnosis, treatment, and follow-up. METHODS:For the 2025 guidelines, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS:The key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with MMIBC. The guidelines stress the importance of a multidisciplinary approach to the treatment of MMIBC patients and the importance of shared decision-making with patients. The key changes in the 2025 muscle-invasive bladder cancer (MIBC) guidelines include the following: a new recommendation for the use of susceptible FGFR3 alterations to select patients with unresectable or metastatic urothelial carcinoma for treatment with erdafitinib; significant adaption and update of the recommendations for pre- and postoperative radiotherapy and sexual organ-preserving techniques in women; new recommendation related to radical cystectomy and extent of lymph node dissection based on the results of the SWOG trial; recommendation related to hospital volume; new recommendations for salvage cystectomy after trimodality therapy and for the management of all patients who are candidates for trimodality bladder-preserving treatment in a multidisciplinary team setting using a shared decision-making process; significant adaption and update to the recommendation for adjuvant nivolumab in selected patients with pT3/4 and/or pN+ disease not eligible for, or who declined, adjuvant cisplatin-based chemotherapy; and addition of a new recommendation for metastatic disease regarding the antibody-drug conjugate trastuzumab deruxtecan in case of HER2 overexpression; in addition, removal of the recommendations on sacituzumab govitecan as the manufacturer has withdrawn the US Food and Drug Administration approval for this product; update of the follow-up of MIBC; and full update of the management algorithms of MIBC. CONCLUSIONS AND CLINICAL IMPLICATIONS:This overview of the 2025 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, treatment, and follow-up of MIBC patients and is designed for effective integration into clinical practice.

CASSIOPE was a real-world study of cabozantinib use as a second-line or later-line therapy for advanced renal cell carcinoma after prior VEGF-targeted therapy. Of 679 patients prospectively enrolled in Europe, second-line or later-line cabozantinib use was shown to be effective and manageable in a real-world setting and had a safety profile consistent with previous studies. Background: There is a lack of published data on real-world cabozantinib use in patients with advanced renal cell carcinoma after prior vascular endothelial growth factor (VEGF)-targeted therapy. Methods: CASSIOPE was a real- world, prospective, multicenter, non-interventional postauthorization safety study of cabozantinib in adult patients with advanced renal cell carcinoma in Europe following prior VEGF-targeted treatment (NCT03419572). Endpoints included cabozantinib utilization (dose modifications due to adverse events [AEs; primary endpoint], dose, dose modifications, and treatment duration), safety, effectiveness (progression-free survival [PFS], overall survival [OS], best overall response [BOR]), and healthcare resource utilization. Findings: Full analysis set (FAS)/safety population comprised 679 patients; 433 of these initiated cabozantinib at 60 mg/day (recommended dose) (primary safety population). Median age (FAS) was 67 (range, 29-93) years; most were male (73 0%), had clear-cell histology (85 7%), metastatic disease at cabozantinib initiation (97 8%), and prior nephrectomy (80 3%). In the primary safety population, 77 1% experienced dose modification owing to an AE. In the safety population, the median daily dose was 40 0 (range, 7 8-60 0) mg/day and the median treatment duration was 7 8 (< 0 1-15 2) months. Treatment-emergent and treatment-related AEs were experienced by 95 9% and 90 4% of patients, respectively. Median PFS (FAS) assessed by the local investigator using any method was 8 3 months, and 1-year OS rate was 74%. Approximately one-third of all patients had a BOR of partial response and 6 had a complete response. Interpretation: Second- or later-line cabozantinib was effective and manageable in a real-world setting and had a safety profile consistent with previous studies.

It is currently recommended to perform open radical nephroureterectomy (oRNU) with bladder cuff excision in patients with locally advanced (cT3-4 or cN1-2) upper tract urothelial carcinoma (laUTUC). We tested the hypothesis that bladder recurrence-free survival (BRFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) are not influenced by the surgical approach in patients with laUTUC using a large multicenter series. This was a multicenter retrospective cohort study including 361 patients with preoperative cT3-4 cM0 or cN1-2 cM0 laUTUC treated with open or minimally invasive RNU from 1999 to 2019 at 21 academic centers in Europe, Asia, and the United States. Missing values of relevant baseline characteristics were estimated through multiple imputation of chained equations. Baseline patients’ heterogeneity was balanced using a 1:1 propensity score matching estimated using logistic regression. Uni- and multivariable Cox regression analyses for bladder recurrence, metastasis, cancer-specific death and overall death were performed according to clinical and pathological characteristics. Kaplan Meier (KM) estimates and log-rank test were used to compare BRFS, MFS, CSS and OS according to clinical and pathological features. Median follow-up was 28 months. After propensity score matching, two cohorts of 115 laUTUC patients each with similar baseline and preoperative tumor characteristics were obtained. In the matched cohort, pT ≥ 3 stage was found in 84 (73