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Diagnosis and Therapy in Urothelial Cancer

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Dear Colleagues,

Urothelial cancer represents a constantly growing challenge in the urological scenario. Continuous diagnostic innovations, such as the introduction of new biomarkers, and therapeutic innovations with the use of new immunotherapeutic drugs or engineered target therapies in association with new robotic platforms have significantly improved the management of the disease. The aim of this Special Issue is to summarize the best and most innovative papers in the diagnostic and therapeutic field related to urothelial neoplasia.

Dr. Giuseppe Palermo
Guest Editor

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Research

13 pages, 715 KB

Open AccessArticle

Survival Outcomes of BCG Only, BCG Plus EMDA-MMC or Upfront Radical Cystectomy in High-Risk Non-Muscle Invasive Bladder Cancers (NMIBCs): A Multicentre, International, Collaborative Study from Tertiary Referral Institutions

by Francesco Del Giudice, Valerio Santarelli, Amir Khan, Mohamed Gad, Katarina Spurna, Syed Ghazi Ali Kirmani, Noor Huda Bhatti, Rajesh Nair, Kathryn Chatterton, Suzanne Amery, Elsie Mensah, Benjamin Challacombe, Youssef Ibrahim, Felice Crocetto, Giuseppe Basile, Roberta Corvino, Eleonora Razeto, Matilde Verde, Vincenzo Asero, Ettore De Berardinis, Giulio Garaffa, Jan Łaszkiewicz, Aleksander Ślusarczyk, Francesco Claps, Benjamin I. Chung, Ramesh Thuraraja, Timothy O’Brien, Muhammad Shamim Khan and Yasmin Abu-Ghanem Show full author list Hide full author list

Cancers 2026, 18(3), 500; https://doi.org/10.3390/cancers18030500 - 3 Feb 2026

Viewed by 714

Abstract

Introduction: Conservative or upfront radical management for high- and very high-risk non-muscle-invasive bladder cancer continues to be debated, particularly for cases with adverse pathological features. We aimed to compare survival outcomes among NMIBC patients treated with transurethral resection of bladder tumour (TURBT) followed by either Bacillus Calmette–Guérin (BCG), sequential BCG plus electromotive administration of mitomycin C (EMDA-MMC), or upfront radical cystectomy (RC). Materials and Methods: High- and- very high-risk NMIBC cases undergoing TURBT followed by BCG, BCG plus EMDA-MMC, or RC at two international tertiary referral centres between 2009 and 2024 were retrospectively reviewed. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier methods. Multivariable Cox regression models were applied to identify factors independently associated with survival outcomes. Results: A total of 1178 patients were included: 852 received BCG, 249 received BCG/EMDA-MMC, and 77 underwent upfront RC. Kaplan–Meier analysis revealed no significant differences in RFS or PFS between the BCG and BCG/EMDA-MMC groups, nor in OS between the three treatment strategies. According to multivariable analysis, concomitant carcinoma in situ (CIS) and increasing T stage at TURBT were independently associated with poorer RFS (HR 1.39; 95% CI 1.05–1.85), PFS (HR 1.95; 95% CI 1.36–2.82), and OS (HR 2.28; 95% CI 1.60–3.25). A second resection conferred a protective effect on PFS (HR 0.72; 95% CI 0.54–0.95). Treatment modality (BCG, BCG/EMDA-MMC, or upfront RC) was not significantly associated with any survival endpoint. Conclusions: In this large multicentre series of patients with high- and very high-risk NMIBC undergoing TURBT, survival outcomes were primarily influenced by clinical–pathological characteristics rather than the adjuvant treatment of choice. Full article

(This article belongs to the Special Issue Diagnosis and Therapy in Urothelial Cancer)

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14 pages, 458 KB

Open AccessArticle

Contemporary Trends and Predictors of pT0 in Radical Cystectomy Specimens Among Non-Muscle and Muscle-Invasive Bladder Cancer Patients: A Propensity Score-Matched Analysis from a Single Tertiary Centre in the United Kingdom

by Francesco Del Giudice, Valerio Santarelli, Katarina Spurna, Syed Ghazi Ali Kirmani, Noor Huda Bhatti, Yasmin Abu-Ghanem, Elsie Mensah, Benjamin Challacombe, Samuel J. Davies, Mohammad Hegazy, Youssef Ibrahim, Mohammed Gad, Amir Khan, Roberta Corvino, Felice Crocetto, Jan Łaszkiewicz, Bernardo Rocco, Benjamin I. Chung, Ramesh Thuraraja, Muhammad Shamin Khan and Rajesh Nair Show full author list Hide full author list

Cancers 2025, 17(19), 3110; https://doi.org/10.3390/cancers17193110 - 24 Sep 2025

Cited by 1 | Viewed by 918

Abstract

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 and p = 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. Full article

(This article belongs to the Special Issue Diagnosis and Therapy in Urothelial Cancer)

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