Search Results (1,505)

Background/Objectives: Behçet’s disease is a chronic relapsing multisystem inflammatory disorder characterized by recurrent mucocutaneous ulceration, vasculitis, and exaggerated inflammatory responses to minor trauma. These features may adversely affect wound healing after major head and neck oncologic reconstruction. This case report describes repeated wound breakdown after oral cavity reconstruction in a patient with Behçet’s disease and advanced floor-of-mouth squamous cell carcinoma. Methods: A 51-year-old woman with Behçet’s disease and T4N2bM0 squamous cell carcinoma involving the floor of the mouth and tongue underwent tumor resection followed by reconstruction of the oral cavity defect using a right anterolateral thigh perforator free flap. Subsequent surgical procedures included debridement of necrotic tissue, negative-pressure wound therapy, split-thickness skin grafting of the thigh donor site, and salvage tumor resection with pectoralis major myocutaneous flap reconstruction after tumor recurrence. Results: After the initial anterolateral thigh free flap reconstruction, flap perfusion was satisfactory in the immediate postoperative period; however, delayed marginal necrosis developed from the distal tongue-side flap margin, whereas the floor-of-mouth portion remained relatively stable. The right thigh donor site also developed progressive suture-line necrosis and wound dehiscence, requiring operative debridement, negative-pressure wound therapy, and split-thickness skin grafting. Although skin grafting achieved eventual donor-site coverage, partial graft necrosis and delayed secondary healing occurred. Persistent fistula and wound instability delayed postoperative radiotherapy, and recurrent floor-of-mouth squamous cell carcinoma subsequently developed approximately 6 months after the initial surgery. After salvage resection and pectoralis major myocutaneous flap reconstruction, the flap appeared viable at inset, but marginal ecchymosis, partial necrosis, and wound dehiscence again developed, requiring additional debridement, quilting sutures, and negative-pressure wound therapy. The wound gradually stabilized with staged wound management. Conclusions: This case illustrates a multifactorial pattern of repeated marginal wound breakdown after technically successful flap reconstruction in a patient with Behçet’s disease. Behçet-related pathergy-like inflammation, vasculitis, and microcirculatory dysfunction may represent possible contributing mechanisms, but they were not directly proven in this patient. In oral cavity reconstruction, such wound instability may delay adjuvant therapy and adversely affect oncologic outcomes. Careful perioperative planning, close multidisciplinary coordination, meticulous tension-free closure, early recognition of wound compromise, and readiness for staged wound management are essential in patients with Behçet’s disease undergoing major head and neck oncologic reconstruction. Full article

The development of sustainable and efficient plant growth substrates is crucial for modern agriculture. This study assessed the potential of plant pellets formulated from various lignocellulosic residues, either with or without bamboo biochar (BB-char) and arbuscular mycorrhizal fungi (AMF), to support seed germination and early seedling growth. Four types of residues, including coconut coir (CO), corn cob (CC), leaves from the genus Dipterocarpus (DL), and teak leaves (TL), were combined with soil and paper waste to produce eight pellet formulations, with commercial peat pellets serving as a control. Chemical analyses revealed significant variation among the pellet types, with pH values ranging from 6.40 to 7.65, electrical conductivity (EC) from 3.64 to 11.62 mS cm⁻¹, and differences in organic matter, carbon, and nutrient contents [nitrogen (N), phosphorus (P), potassium (K)], reflecting the influence of residue type and the addition of BB-char and AMF. Phytotoxicity screening using aqueous extracts demonstrated species-specific responses, with cucumber exhibiting high tolerance across treatments, whereas chili seeds were more sensitive. Final germination percentage (FGP) and seedling growth assays in greenhouse conditions showed that pellets derived from CC and CO, particularly when combined with BB-char and AMF (T6 and T7), enhanced shoot and root development in carrot, chili, cucumber, and tomato, approaching the performance of commercial peat pellets. In contrast, DL- and TL-based pellets resulted in lower germination and growth. These findings indicate that both the physicochemical properties of lignocellulosic wastes and the combination of BB-char and AMF are important factors influencing pellet efficacy, highlighting the potential of CC- and CO-based pellets as sustainable peat alternatives for early-stage plant cultivation. Full article

Background: Spatial cognition, a skill paramount to survival, is impaired in Parkinson’s disease (PD) but has been little researched. Spatial cognition is utilized during motor–cognitive integration, which impacts daily functioning and quality of life in PD. As PD is a unilateral-onset condition, spatial–cognitive and motor–cognitive ability may differ by side of onset. Spatial cognition is suggested to be modulated by the right hemisphere; thus, we hypothesize to observe worse spatial and motor–cognitive performance by people with left-onset PD (LOPD) than right-onset PD (ROPD). Methods: 216 participants with PD were recruited (LOPD = 107; M = 62; mean age = 69.80 ± 8.5). Spatial outcomes were collected via the body position spatial task (BPST), Reverse Corsi Blocks, and visuospatial items of the Montreal Cognitive Assessment (MoCA); motor–cognitive outcomes were collected by a Trails test, a Four Square Step Test (FSST), and a Timed Up and Go test. An independent t-test and the Mann–Whitney U test compared outcome variables between onset groups. Results: No significant differences were found between onset groups. Exploratory subgroup analyses revealed differences. Significantly worse performance by LOPD in single- and dual-task TUG was found within people with bilateral symptoms and postural instability (Hoehn & Yahr stage, >2; LOPD, N = 33; single, p = 0.001; dual, p = 0.021) and worse performance in single-task TUG in people with MoCA < 18 (LOPD, N = 5; single, p = 0.036) and people with freezing of gait (FOGQ, >0; LOPD, N = 14, p = 0.048). Significantly larger DTC by LOPD was found within frequent freezers (FOGQ, >3; LOPD, N = 9; p = 0.003). Conclusions: LOPD may tend to perform worse in motor–cognitive tasks among subgroups of those with more severe symptoms, i.e., those at later stages of disease. These findings may have implications for prognoses of those with LOPD versus ROPD and suggest that those with LOPD may have worse long-term outcomes in spatial cognition and motor–cognitive integration. Full article

Large language models (LLMs) are increasingly explored for clinical use. However, the extent to which such models can reliably support physicians in reporting, staging, and the assessment of classification remains an active area of research. This study aimed to evaluate and compare multiple LLMs for automated PROMISE V2 classification for prostate cancer. A total of 126 unambiguous German-language PSMA PET/CT text reports were retrospectively analyzed, with reference standards established by expert consensus based on image interpretation and the original report text. Five LLMs (GPT-5.4, DeepSeek-V3.2, Claude Sonnet 4.6, Gemini 3 Flash and Grok 4) were assessed using two English-language prompting strategies of varying complexity. Agreement with the reference standard served as the primary endpoint. Performance varied in the short-prompt setting (36.5–79.4%) but improved consistently with the long prompt (74.6–86.5%), with Gemini 3 Flash achieving the highest agreement. Across PROMISE V2 subcategories, agreement rates were high (miT: 81.0–92.1%, miN: 92.9–96.0%, miM: 92.9–95.2%), despite inter-model differences. In conclusion, contemporary LLMs demonstrate promising performance in deriving PROMISE V2 scores from unambiguous original report texts, particularly when guided by detailed prompts. Full article

RGB-T pedestrian detection remains challenging under low-light, occluded, crowded, and complex-background conditions. To improve cross-modal feature fusion while maintaining model efficiency, this paper proposes MCFusion, a lightweight RGB-T pedestrian detection method with progressive thermal compensation. MCFusion adopts a dual-branch RGB–thermal feature extraction structure and introduces a Modality-Compensated Gated Fusion (MCGF) module at the P4 and P5 semantic stages, which is implemented as a zero-initialized residual compensation mechanism. MCGF uses RGB features as the primary stream and progressively compensates them with thermal auxiliary features through a zero-initialized convolutional gate, reducing the interference caused by direct fusion. In addition, a Lightweight Shared Convolutional Detection Head (LSCD) is adopted to reduce redundant computation in multi-scale prediction. On the LLVIP dataset, MCFusion achieves 95.30% mAP₅₀ and 60.10% mAP_50:95 with 5.21 M parameters and 10.50 GFLOPs. Compared with the YOLOv11n RGB baseline, it improves mAP₅₀ and mAP_50:95 by 7.50 and 10.70 percentage points, respectively. Experiments on KAIST, ablation studies, and visualization results further demonstrate the effectiveness of the proposed method. Full article

Background: Neoadjuvant partial breast irradiation using stereotactic body radiotherapy (SBRT) has emerged as a strategy to induce tumor and immune responses in early-stage, low-risk breast cancer. While prior studies have demonstrated encouraging response rates and evidence of immune modulation, the optimal radiotherapy regimen for immune priming remains unclear. SIGNAL 2.0 is a randomized phase II trial designed to compare the biological and immunological impact of a single-fraction versus three-fraction neoadjuvant SBRT. Materials and Methods: Sixty-one postmenopausal patients ≥ 50 years with unifocal, hormone positive, node-negative invasive ductal carcinoma < 3 cm were randomized 1:1 to receive either 21 Gy in one fraction or 30 Gy in three fractions, delivered to the tumor in the prone position. Core biopsies were collected pre-SBRT and 14–20 days post-SBRT at the time of surgery. Immune markers were assessed using tumor-infiltrating lymphocyte (TIL) scoring, NanoString nCounter PanCancer Immune Profiling, and NanoString GeoMx Digital Spatial Profiling (DSP). Results: Available tumor samples from 47 patients underwent paired tissue analysis. Three-fraction SBRT induced 200 differentially expressed genes, including enrichment of pathways related to adaptive immune activation, with significant increases in expression levels of macrophages, dendritic cells, neutrophils and CD8 T-cells. Proteomic profiling also identified a significant increase in the expression levels of neutrophils, Treg cells, macrophages, and NK cells in the tumor microenvironment of the samples from patients receiving the three-fraction regimen. Conclusions: Neoadjuvant SBRT induces measurable immune activation, with three-fraction regimens generating more extensive transcriptional, proteomic, and cellular immune changes than a single fraction. Three-fraction neoadjuvant SBRT may provide superior immune priming, providing a foundation for future trials integrating neoadjuvant radiotherapy with immunomodulatory therapies. Full article

Background: Plasma biomarkers are promoted as scalable tools for the staging of Alzheimer’s disease (AD), yet head-to-head comparisons against the clinical scales used to define diagnostic labels remain scarce. Reported gains from machine learning fusion of clinical and biomarker features may reflect label circularity rather than biological signals, and quantifying this circularity is a central aim of the present work. Methods: From the Alzheimer’s Disease Neuroimaging Initiative (ADNI), we assembled 655 participants (CN = 296, MCI = 168, and AD = 191) with concurrent plasma biomarkers (pT217, A$\beta$42/40, NfL, and GFAP), clinical scales (MMSE, CDR-SB, and FAQ), APOE genotype, and demographics. Three pre-specified feature sets (clinical-only, biomarker plus demographic–genetic, and full fusion) were compared across four classifiers (Logistic Regression, SVM, Random Forest, and XGBoost) using repeated, nested cross-validation (5-fold × 3 outer, 5-fold inner) with balanced class weighting. Because the external Center for Neurodegeneration and Translational Neuroscience (CNTN) cohort ($n=130$) measures pT181 rather than pT217 and lacks A$\beta$42/40, external evaluation used a separate reduced feature panel (NfL, GFAP, APOE, age, sex, and education), not the proposed pT217-inclusive panel. Results: Clinical scales alone reached a three-class AUC-OVR of $0.9539\pm 0.0041$, and fusion reached $0.9559\pm 0.0046$, an indistinguishable gain. Because MMSE, CDR-SB, and FAQ partly determine ADNI diagnostic labels, both estimates are circularity-inflated upper bounds and do not reflect independent classification power. Independent of this circularity, the internal plasma plus demographic–genetic model still achieved AUC-OVR $=0.7455\pm 0.0150$, with pT217 as the dominant contributor. Pairwise discrimination was excellent for CN vs. AD ($1.0000$) and MCI vs. AD ($0.9739$) but markedly weaker for CN vs. MCI ($0.9302$ for fused and $0.6972$ for plasma only). The separate reduced-feature model, which contains neither pT217 nor A$\beta$42/40, transferred to CNTN with AUC-OVR $=0.702$ (95% CI $0.635$–$0.764$). Conclusions: Apparent fusion gains in ADNI are largely a consequence of label circularity. After removing the circular clinical features, the internal pT217-inclusive plasma model supports three-class CN/MCI/AD screening at AUC $\approx 0.74$ and a reduced panel without pT217 transfers to an independent cohort at AUC $\approx 0.70$. These values provide a realistic performance estimate for blood-based AD staging under the current feature set, diagnostic label structure, and cohort design, and richer feature sets or pathology-anchored labels may shift this estimate. MCI detection remains the principal bottleneck. Full article

Background: In the immunotherapy era, cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) is increasingly performed after neoadjuvant immune checkpoint inhibitor (ICI)-based therapy. Examination of the nephrectomy specimen may capture the depth of treatment-induced tumor clearance more accurately than size-based radiological criteria alone. However, pathological reporting is highly heterogeneous across studies: residual viable tumor (RVT), necrosis, pT stage, and binary downstaging have all been used, limiting reproducible cross-study comparison. We aimed to characterize this heterogeneity, assess its implications for evidence synthesis, and propose a pragmatic framework for qualitative interpretation. Methods: PRISMA-compliant systematic review of studies reporting pathological response and oncological outcomes in mRCC patients undergoing CN after neoadjuvant systemic therapy (PROSPERO CRD420251154068). A qualitative synthesis was performed. A three-category Pathological Response Category (PRC) framework is proposed to harmonize heterogeneous metrics. Results: Seven retrospective studies (n = 408) were included. Pathological reporting metrics were inconsistent across all studies, preventing formal meta-analysis. Nevertheless, across cohorts reporting survival outcomes, deeper pathological response was directionally associated with more favorable oncologic outcomes. A discordance between radiological and pathological response was observed, including near-complete tumor clearance in patients classified as radiologically stable, reflecting the non-size-based mechanisms of ICI-induced tumor killing. Conclusions: The central finding of this review is not that pathological response predicts survival—which is expected—but that current pathological reporting in the mRCC surgical setting is too heterogeneous to quantify the frequency, depth, or prognostic significance of that response in a reproducible way. Prospective adoption of standardized pathological reporting protocols is the most critical next step for this field. Full article

To ensure the reliability and sustained performance of industrial photovoltaic (PV) systems, fault detection frameworks must achieve both high detection accuracy and computational efficiency, particularly for deployment on resource-constrained edge platforms. This work proposes a lightweight and low-latency photovoltaic defect detection framework that integrates DCGAN-based generative augmentation with the proposed GhostViT-YOLOv10n architecture. The augmentation strategy helps address class imbalance, improve representation of rare defects, and enhance generalization capability in electroluminescence (EL) imagery through structured geometric and photometric transformations. The proposed framework integrates lightweight Ghost-based optimization, Cross-Stage Partial Fusion (C2f), Spatial Pyramid Pooling—Fast (SPPF), MobileViT contextual learning, and SimAM-based attention refinement to improve multi-scale feature extraction while maintaining low computational complexity. Experimental evaluation on the PVEL-AD and PV Multi Defect benchmark datasets demonstrates strong detection performance. On the PVEL-AD dataset, the BaseLine achieves a mAP@0.5 of 71.6% with only 2.7 M parameters and 8.4 GFLOPs, while our proposed GhostViT-YOLOv10n framework with DCGAN-enhanced version further improves detection performance to 93.6% mAP@0.5 with only 2.19 M parameters and 6.6 GFLOPs. On the PV Multi Defect dataset, the BaseLine achieves a mAP@0.5 of 74.0% with 2.71 M parameters and 8.4 GFLOPs, and the optimized framework with DCGAN-augmented configuration further improves performance to 95.4% mAP@0.5 with 2.58 M parameters and 7.7 GFLOPs. These results demonstrate the effectiveness of combining lightweight architectural optimization with generative augmentation for improving rare defect representation and multi-scale photovoltaic defect detection. To validate practical deployment feasibility, the optimized framework was deployed on a Raspberry Pi 5 using ONNX Runtime under CPU-only conditions. The deployed model achieved an average inference time of 43.05 ms and a real-time processing speed of 23.23 FPS while maintaining moderate CPU utilization and stable thermal behavior. These deployment results demonstrate the suitability of the proposed framework for lightweight edge-oriented photovoltaic inspection applications without requiring GPU acceleration. All evaluations were conducted exclusively on real test datasets, while synthetic samples were used only during training to improve data diversity and rare defect representation. Overall, the proposed framework provides a balanced solution that combines detection accuracy, computational efficiency, lightweight edge deployment capability, and generative augmentation for practical photovoltaic defect inspection applications with potential suitability for future drone-assisted inspection scenarios. Full article

Background: Small cell lung cancer (SCLC) is an aggressive malignancy that has traditionally been treated as a systemic disease, with surgery largely excluded from standard management. A small subset of patients, however, present with clinical Stage I disease (T1–2N0M0). With improvements in imaging, staging, and systemic therapy, local therapy warrants consideration. Methods: We performed a narrative review of the literature focused on clinical Stage I SCLC, prioritizing studies addressing epidemiology, tumor biology, diagnostic workup, staging, treatment approaches, and surveillance. Emphasis was placed on current guideline recommendations and contemporary retrospective data relevant to surgical and non-surgical local therapies. Results: Clinical Stage I SCLC is rare and is frequently upstaged with complete diagnostic evaluation, highlighting the need for thorough staging and pathologic confirmation of node-negative disease when surgery is considered. Even in presumed local disease, distant metastases are many times evident with a proper staging workup. Retrospective analyses suggest potential for long-term control of disease in carefully selected Stage I patients treated with surgical resection, particularly lobectomy, as part of multimodality therapy that includes adjuvant systemic therapy. For patients who are not surgical candidates, stereotactic body radiation therapy combined with systemic therapy is a reasonable alternative. The role of prophylactic cranial irradiation and optimal surveillance strategies in Stage I disease remain areas of uncertainty. Conclusions: Clinical Stage I SCLC affects a small and unique group of patients where traditional treatment strategies may need to be reconsidered. Taken together, retrospective evidence suggests a survival benefit for surgery in carefully selected patients, although prospective validation is lacking. Surgery warrants consideration in appropriately staged, operable patients, while recognizing the limitations of existing data and the need for further study in this rare population. Full article

Conventional spring sowing of sugar beet in Europe faces increasing constraints from summer drought, high temperatures, and Cercospora beticola pressure due to climate change. This two-year field trial (2021–2022 and 2022–2023) evaluated the feasibility of autumn-sown sugar beet at a northern Mediterranean site in Legnaro (Padua, NE Italy, 45°21′ N). Nine varieties were assessed across four sowing dates in 2021 (late September to early November) and two sowing dates in 2022 (late September and late October). Measurements included overwinter survival, bolting incidence at two reproductive stages, fresh root and above-ground biomass yield at sequential harvest dates, and root soluble solids (°Brix). Post-winter mortality was negligible following September and early-October sowings, moderate after late-October sowings (17.3% in 2021; 13.2% in 2022), and extremely high after early-November sowing (81.5%). These patterns indicated that winter survival was more strongly determined by crop developmental stage before winter than by seasonal minimal temperatures recorded in two seasons (−3.6 °C and −6.3 °C, respectively). Bolting incidence showed the opposite trend, reaching near-complete or complete expression in the earliest sowings regardless of variety choice. In late-October sowings, clear varietal differences emerged. Some varieties combined low bolting incidence with high root yields, reaching 81.1–84.4 t ha⁻¹ at the final harvest (early August 2023). Root juice soluble solids were higher in the drier 2021–2022 season (exceeding 20 °Brix in several cases) than in the wetter 2022–2023 season (consistently below 17.5 °Brix), reflecting dilution effects associated with the different seasonal precipitation. In the sequential harvest series of late-October 2022 sowing, later harvest dates were generally associated with lower soluble solids. These results indicate that, within the autumn sowing window evaluated, late-October sowing combined with appropriate varietal selection provided the best balance between overwinter survival, bolting incidence, and root yield at this northern Mediterranean latitude. Future multi-site studies, including spring-sown controls, could enable direct comparison with conventional sowing practice. Full article

Background: Image-guided thermal ablation has been used for the treatment of primary lung carcinoma but its use in the treatment of multiple lung carcinoma and effects on survival have not been well established. Objective: This study compares the long-term survival metrics for stage 1 single primary lung cancer and multiple primary lung cancer (MPLC) in patients treated with image-guided thermal ablation (IGTA). Methods: A retrospective institutional review included 37 NSCLC patients (mean age 71.6 ± 8.8 years) with ≥5 years follow-up. In total, 119 IGTA procedures were performed. Among patients with a single tumor (n = 14, 37.8%), each underwent a single ablation session. In contrast, patients with MPLC (n = 23, 62.2%) underwent 88 ablation sessions to treat 105 tumors. Data included demographics, tumor features, procedural details, safety, adverse events, and outcomes. Primary endpoints were 5-year overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS). Results: All ablations were completed successfully. Severe AEs occurred in 5.8% (7/119) of the ablations and were limited to pneumothorax requiring chest tube placement with hospitalization. At the time of ablation, individual nodules were staged at T1A = 46 (38.7%), T1B = 54 (45.4%), T1C = 16 (13.5%) and T2A = 3 (2.5%). Local recurrence was observed in 4/119 (3.3%) ablated tumors, all at stage T1B, and all were retreated with ablation. The 5-year OS was better for patients with MPLC at 85.6% compared to patients with a single tumor at 35.7% (HR = 0.14, p = 0.003, 95% CI: 0.037, 0.51). The 5-year OS for tumors based on T classification for T1A, T1B, TIC and T2A was 71.4%, 66.8%,66.7% and 0%. The 5-year PFS was 77.4% for patients with MPLC compared to 35.7% for patients with single primary lung cancer (HR = 0.25, p = 0.014, 95% CI: 0.084, 0.76). The 5-year CSS was 95.2% for patients with MPLC compared to 83.1% for patients with single primary lung cancer (HR = 0.21, p = 0.16, 95% CI: 0.018, 2.33). Conclusions: IGTA is an effective and safe treatment for patients with stage 1 single primary lung cancer and MPLC with limited local recurrence. Tumor size up to 3 cm did not have significant impact on survival. Overall survival was improved in patients with MPLC compared to those with single NSCLC. Clinical Impact: IGTA can be safely performed in patients with single primary lung cancer and MPLC, with limited local recurrence rate. Highlights: Key Findings: IGTA effectively treats patients with stage 1 single primary lung cancer and MPLC, with 3.3% recurrence, which can be retreated with ablation. The five-year OS was higher in patients with MPLC (85.6%) versus those with single lung cancer (35.7%, p = 0.003). OS by T classification: 71.4% for T1A, 66.8% for T1B, 66.7% for TIC, and 0% for T2A. Importance: IGTA effectively treats patients with single primary lung cancer and MPLC with low recurrence. Tumor size < 3 cm showed no impact on overall survival. Full article

In order to describe the heavy ion collision dynamics which implies the formation of hot and very dense nuclear matter in the overlapping region of the two colliding nuclei, we used simulated numerical calculations for FAIR available energies. We used the anti-$k_T$ jet-detection algorithm for highlighting the main directions of flow in Au-Au collisions at CBM energies, thus obtaining structures of the events depending on the number of flow streams. The jet-finder algorithm identified domains in the y-$\psi$ (rapidity-azimuthal angle) plane, where the number of charged particles, momenta and energy take higher values compared to other areas of this plane. The anisotropic flow coefficients $v_n$ may offer information about the pressure gradients in the early stages of the collision and about the high-density nuclear matter properties. The observation of $K^{+}$ mesons in heavy ion collisions is of interest since $K^{+}$ mesons, due to their strangeness, have a mean free path that exceeds the dimensions of the “fireball”. In the numerical calculations the interval of rapidity $0<y<0.8$ is highlighted, for which the fluctuations of the antiparticle to particle ratio excitation functions show non-monotonic behavior in the 10–13 A GeV energy interval. Full article

Background and Objectives: Pathological upstaging from non-muscle-invasive bladder cancer (NMIBC) to muscle-invasive disease (MIBC) at radical cystectomy (RC) compromises preoperative risk stratification and may deprive patients of the survival benefit conferred by neoadjuvant chemotherapy. This study aimed to define the frequency and independent predictors of pathological upstaging in a contemporary single-institution cohort, and to characterise its impact on recurrence-free, disease-specific, and overall survival. Materials and Methods: We conducted a retrospective review of a prospectively maintained database of all patients who underwent RC and pelvic lymphadenectomy for urothelial bladder cancer at our institution between January 2009 and December 2023. Upstaging was defined as the final pathological stage ≥ pT2 or pN+ from a clinical stage of <T2N0M0. Clinicopathological factors were evaluated for their association with upstaging using chi-squared, Fisher’s exact, and logistic regression analyses. Survival outcomes—recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS)—were estimated by the Kaplan–Meier method and compared using the log-rank test. Multivariable Cox proportional hazards regression identified independent prognostic factors. Results: Of 1002 patients who underwent RC during the study period, complete clinicopathological data were available for 826. Primary clinical stage at presentation was MIBC (≥T2) in 448 (54.2%) and NMIBC (<T2) in 378 (45.8%). Among NMIBC patients, 102 (27.0%) were upstaged to MIBC at final pathology. Multivariable logistic regression identified concomitant carcinoma in situ (CIS) (p = 0.042), variant histology—predominantly squamous differentiation (p = 0.003)—and urethral involvement (p = 0.003) as independent predictors of upstaging. Upstaged patients had significantly worse 5-year RFS (p < 0.001), DSS (p = 0.01), and OS (p < 0.001) compared with patients who remained NMIBC. No statistically significant difference in survival was observed between patients upstaged at RC and those presenting with primary MIBC. Conclusions: Pathological upstaging occurs in more than a quarter of patients undergoing RC for NMIBC and confers a survival penalty equivalent to that of primary MIBC. Concomitant CIS, variant histology, and urethral involvement identify those at highest risk. These patients warrant aggressive preoperative counselling, expedited surgical planning, and consideration of perioperative systemic therapy. Full article