Tumor site as predictors of pathologic progression in high-grade T1 bladder cancer

To evaluate the association between tumor location and progression or recurrence after initial transurethral resection of bladder tumor (TURBT) in patients with high grade (HG) T1 urothelial carcinoma.

This retrospective cohort analysis included patients diagnosed with HG-T1 bladder cancer from 2020 to 2024. Patients were stratified by tumor location: anterior/posterior wall, lateral walls, bladder neck, trigone, dome. Residual disease or upstaging at restaging TURBT was assessed via follow-up restaging TURBT. Associations were tested using chi-square, univariate, and multivariate models.

A total of 80 patients with high-grade T1 urothelial carcinoma were included. The median age was 73 years (range 45-89) and 92.8% (77) were male. The mean tumor size was 2.6 cm, and 91.3% of tumors were completely resected. Tumors were most commonly located in the lateral wall (36.3%) and posterior wall (31.3%). Worsening on restaging TURBT was most frequent in posterior wall (48.4%) and bladder neck tumors (50%). Lateral wall tumors worsened in 37.0%, anterior wall in 23.1%, and none from the trigone. Posterior wall tumors showed higher odds of worsening versus dome tumors in univariate analysis (OR 2.50, p = 0.34), though not statistically significant. Multivariable analysis adjusting for clinical and tumor factors also found non-significant increased odds for posterior wall tumors versus lateral wall and dome (OR 1.26, p = 0.71).

Posterior wall and bladder neck tumors showed the highest descriptive rates of residual disease or upstaging at restaging TURBT, but multivariable analysis did not demonstrate statistically significant independent associations. These findings may warrent closer surveillance or earlier intervention in select cases.