{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T09:43:38Z","timestamp":1770716618083,"version":"3.49.0"},"reference-count":27,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2012,4,27]],"date-time":"2012-04-27T00:00:00Z","timestamp":1335484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2012,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>The treatment of high\u2010risk nonmuscle\u2010invasive bladder cancer (NMIBC) is difficult given its unpredictable natural history and patient comorbidities. Because current case series are mostly limited in size, the authors report the outcomes from a large, single\u2010center series.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>The authors reviewed all patients with primary, high\u2010risk NMIBC at their institution from 1994 to 2010. Outcomes were matched with clinicopathologic data. Patients who had muscle invasion within 6 months or had insufficient follow\u2010up (&lt;6 months) were excluded. Correlations were analyzed using multivariable Cox regression and log\u2010rank analysis (2\u2010sided; <jats:italic>P<\/jats:italic> &lt; .05).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>In total, 712 patients (median age, 73.7 years) were included. Progression to muscle invasion occurred in 110 patients (15.8%; 95% confidence interval [CI], 13%\u201018.3%) at a median of 17.2 months (interquartile range, 8.9\u201035.8 months), including 26.5% (95% CI, 22.2%\u201031.3%) of the 366 patients who had &gt;5 years follow\u2010up. Progression was associated with age (hazard ratio [HR], 1.04; <jats:italic>P<\/jats:italic> = .007), dysplastic urothelium (HR, 1.6; <jats:italic>P<\/jats:italic> = .003), urothelial cell carcinoma variants (HR, 3.2; <jats:italic>P<\/jats:italic> = .001), and recurrence (HR, 18.3; <jats:italic>P<\/jats:italic> &lt; .001). Disease\u2010specific mortality occurred in 134 patients (18.8%; 95% CI, 16.1%\u201021.9%) at a median of 28 months (interquartile range, 15\u201045 months), including 28.7% (95% CI, 24.5%\u201033.3%) of those who had 5 years of follow\u2010up. Disease\u2010specific mortality was associated with age (HR, 1.1; <jats:italic>P<\/jats:italic> &lt; .001), stage (HR, 1.7; <jats:italic>P<\/jats:italic> = .003), dysplasia (HR, 1.3; <jats:italic>P<\/jats:italic> = .05), and progression (HR, 5.2; <jats:italic>P<\/jats:italic> &lt; .001). Neither progression nor disease\u2010specific mortality were associated with the receipt of bacillus Calmette\u2010Guerin (<jats:italic>P<\/jats:italic> &gt; .6).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Within a program of conservative treatment, progression of high\u2010risk NMIBC was associated with a poor prognosis. Surveillance and bacillus Calmette\u2010Guerin were ineffective in altering the natural history of this disease. The authors concluded that the time has come to rethink the paradigm of management of this disease. Cancer 2012. \u00a9 2012 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.27587","type":"journal-article","created":{"date-parts":[[2012,4,27]],"date-time":"2012-04-27T15:56:13Z","timestamp":1335542173000},"page":"5525-5534","source":"Crossref","is-referenced-by-count":36,"title":["The long\u2010term outcome of treated high\u2010risk nonmuscle\u2010invasive bladder cancer"],"prefix":"10.1002","volume":"118","author":[{"given":"Francis","family":"Thomas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek J.","family":"Rosario","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Rubin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R.","family":"Goepel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maysam F.","family":"Abbod","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W. 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