Outcomes and Predictive Factors for Gynecologic Organ Involvement in Radical Cystectomy for Female Bladder Cancer Patients: A Multicenter Retrospective Cohort Study.

Background and Objectives: Radical cystectomy (RC) is standard treatment for muscle-invasive bladder cancer, but the role of gynecologic organ preservation in women remains uncertain. We primarily evaluated the prevalence and predictors of pathological gynecologic organ involvement and secondarily assessed survival and developed a prediction model. Materials and Methods: This multicenter retrospective study included 232 women undergoing RC at 13 tertiary centers. Of the 232 women, 182 had clinical T2 disease and 50 had BCG-unresponsive or very-high-risk Ta/T1 non-muscle-invasive bladder cancer. Overall survival (OS) was the primary endpoint; CSS and RFS were secondary outcomes. Multivariable logistic regression was used to identify predictors and develop preoperative prediction models. Results: Pathological gynecologic organ involvement was identified in 26 patients (11.2%): uterine in 15 (6.5%), vaginal in 11 (4.7%), ovarian in five (2.2%), and adnexal in 21 (9.1%). The median OS was shorter in patients with involvement than in those without (19.0 vs. 48.0 months; p = 0.048). Vaginal and ovarian involvement were associated with shorter OS (both p < 0.001), whereas uterine and adnexal involvement were not. Pathological T stage was associated with organ involvement (p = 0.001), with the highest frequency in pT4 disease. Model 2 showed an AUC of 0.898 and an optimism-corrected AUC of 0.872. A risk score of 0 classified 31.0% as low risk, with an NPV of 97.2% and a sensitivity of 92.3%. Conclusions: Pathological gynecologic organ involvement was uncommon but associated with poorer survival. These findings may support preoperative risk stratification, although the oncologic safety of organ-preserving surgery cannot be established from pathological involvement data alone.