Neeraja Tillu, MD, discusses predictors of upstaging following RARC for NMIBC

A long-term, multicenter analysis of patients undergoing robot-assisted radical cystectomy for non-muscle invasive bladder cancer identified multiple predictors of upstaging.¹

In an interview with Urology Times®, study author Neeraja Tillu, MD, provided an overview of the study and its notable findings.

“Our multicenter, long-term study examined outcomes in patients diagnosed with non–muscle invasive bladder cancer who had undergone robot-assisted radical cystectomy with intracorporeal urinary diversion. We analyzed data from 355 patients treated between 2004 and 2022 across 3 high-volume institutions. The primary aim was to evaluate the predictors of disease upstaging at the time of surgery and its impact on long-term survival outcomes,” explained Tillu, a urologic oncology fellow at Icahn School of Medicine at Mount Sinai in New York, New York.

Tillu reported that in their cohort, 34.4% of patients experienced upstaging post surgery.

“This group had notably worse overall survival and cancer-specific survival. Key predictors involved with worse overall survival were advanced age (more than 83 years), carcinoma in situ, with concomitant T1 or TA disease, variant histology, squamous cell carcinoma. Conversely, patients with higher BMI [body mass index] and those presenting exclusively with carcinoma in situ were less likely to be upstaged,” Tillu said.

In the interview, Tillu outlined the benefits of discerning predictors of upstaging.

“Identification of significant predictors has improved our pre-op counseling…This sort of transparency…guides in making choices regarding the timing of radical cystectomy,” Tillu said.

REFERENCE

1. Tillu N, Ben-David R, Skokic V, et al. Long-term multicentre analysis of robot-assisted radical cystectomy for non-muscle-invasive bladder cancer. BJU Int. 2025 Feb 20. doi:10.1111/bju.16686