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This study utilizes multi\u2010center cohorts of 2322 patients with pathologically diagnosed BCa, collected between January 1, 2014, and December 31, 2023, to explore the correlation between tumor budding (TB) status and NACI response and disease prognosis. A deep learning model is developed to noninvasively evaluate TB status based on CT images. The deep learning model accurately predicts the TB status, with area under the curve values of 0.932 (95% confidence interval: 0.898\u20130.965) in the training cohort, 0.944 (0.897\u20130.991) in the internal validation cohort, 0.882 (0.832\u20130.933) in external validation cohort 1, 0.944 (0.908\u20130.981) in the external validation cohort 2, and 0.854 (0.739\u20130.970) in the NACI validation cohort. Patients predicted to have a high TB status exhibit a worse prognosis (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.05) and a lower pCR rate of 25.9% (7\/20) than those predicted to have a low TB status (pCR rate: 73.9% [17\/23];\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.001). Hence, this model may be a reliable, noninvasive tool for predicting TB status, aiding clinicians in prognosis assessment and NACI strategy formulation.\n                  <\/jats:p>","DOI":"10.1002\/advs.202416161","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T08:28:20Z","timestamp":1747729700000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Non\u2010Invasive Tumor Budding Evaluation and Correlation with Treatment Response in Bladder Cancer: A Multi\u2010Center Cohort Study"],"prefix":"10.1002","volume":"12","author":[{"given":"Xiaoyang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Urology Third Affiliated Hospital of Sun Yat\u2010sen University Sun Yat\u2010sen University  600th Tianhe Road Guangzhou 510630 P. R. China"},{"name":"Department of Urology Sun Yat\u2010sen Memorial Hospital Sun Yat\u2010sen University  Guangzhou 510120 P. R. 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