Impact of Surgical Wait Time on Survival After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective Cohort Study

Background: Patients with muscle-invasive bladder cancer (MIBC) frequently face delays before radical cystectomy (RC). Prolonged preoperative intervals may permit tumor progression and adversely affect outcomes. This study evaluated the association between preoperative wait time and prognosis in patients with MIBC. Methods: In this retrospective cohort study, we analyzed 83 patients who underwent upfront radical cystectomy between 2017 and 2024. Patients were stratified by preoperative wait time into short-wait (≤14 days) and long-wait (>14 days) cohorts. The primary endpoint was cancer-specific survival (CSS); overall survival (OS) was analyzed as a key secondary endpoint. Clinicopathologic variables were compared between groups, and survival was assessed using Kaplan-Meier methods with Log rank tests and multivariable Cox proportional hazards models. Results: The median preoperative waiting time was 14 days. No significant differences in baseline characteristics were observed between the two groups. In multivariable analysis, shorter wait times were independently associated with improved CSS (HR = 0.40, 95% CI 0.21-0.76; p = 0.005) and OS (HR = 0.41, 95% CI 0.22-0.78; p = 0.007). Smoking (HR = 5.50, p < 0.001), larger tumor size (HR = 1.84, p < 0.001), and ECOG score ≥ 1 (HR = 2.83, p = 0.022) were independent predictors of poorer outcomes. Conclusion: Shorter intervals between diagnosis and surgery were associated with improved survival in MIBC, with the benefit appearing most pronounced in patients with mild-to-intermediate disease severity. Timely surgery remains essential, while individualized scheduling should consider both disease extent and overall patient fitness.