{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:11:07Z","timestamp":1792001467074,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the oncological outcomes of patients with high\u2010risk (HR) and very high\u2010risk (VHR) non\u2010muscle\u2010invasive bladder cancer (NMIBC) treated with upfront radical cystectomy (RC) vs Bacillus Calmette\u2013Gu\u00e9rin (BCG) instillations from a contemporary European multicentre cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 1491 patients diagnosed with HR\u2010 or VHR\u2010NMIBC from a European multicentre database between 2015 and 2024. Patients were included if they received either upfront RC or at least five doses of BCG. A 1:1 propensity score matching (PSM) according to clinically relevant variables was applied. Progression was defined as muscle\u2010invasive or metastatic disease. Cumulative incidence plots and multivariable competing risk regression models addressing cancer\u2010specific mortality (CSM) were fitted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 1221 patients with HR\u2010 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091221 [90%]) or VHR\u2010NMIBC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009121 [10%]), 87 (7.1%) underwent upfront RC. The median follow\u2010up was 2.6\u2009years. After PSM (87 vs 87 patients), the 5\u2010year CSM rate was similar in patients treated with BCG (13%) vs their upfront RC counterparts (16%) (hazard ratio: 1.77, 95% confidence interval [CI] 0.66\u20134.73;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3). Of the 1134 patients who initially received BCG, 73 (6.6%) eventually required delayed RC, with 34 (47%) progressing to muscle\u2010invasive bladder cancer before delayed RC. The 3\u2010year CSM rate was comparable in upfront RC (13%) vs delayed RC (11%) among non\u2010progressing patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3). However, patients who progressed before delayed RC had worse 3\u2010year CSM relative to those who did not (13% vs 31%, hazard ratio: 0.32, 95% CI 0.13\u20130.83;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within a European cohort of patients with HR\u2010 and VHR\u2010NMIBC, upfront RC was rarely performed. Patients treated with BCG did not exhibit a CSM disadvantage relative to their upfront RC counterparts. After matching, long\u2010term CSM was similar between BCG therapy and upfront RC. Delayed RC, led to worse outcomes if performed after progression, but matched upfront RC when performed before progression, underscoring importance of timely surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16675","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:48:31Z","timestamp":1739926111000},"page":"47-54","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Outcomes of\n                    <scp>BCG<\/scp>\n                    vs upfront radical cystectomy for high\u2010risk non\u2010muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6126-9889","authenticated-orcid":false,"given":"Pietro","family":"Scilipoti","sequence":"first","affiliation":[{"name":"Department of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Longoni","sequence":"additional","affiliation":[{"name":"Department of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0494-7839","authenticated-orcid":false,"given":"Mario","family":"de Angelis","sequence":"additional","affiliation":[{"name":"Department of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Zaurito","sequence":"additional","affiliation":[{"name":"Department of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4344-0191","authenticated-orcid":false,"given":"Aleksander","family":"\u015alusarczyk","sequence":"additional","affiliation":[{"name":"Department of General, Oncological and Functional Urology Medical University of Warsaw  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-8453","authenticated-orcid":false,"given":"Francesco","family":"Soria","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital University of Studies of Torino  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Pradere","sequence":"additional","affiliation":[{"name":"Department of Urology UROSUD La Croix Du Sud Hospital  Quint\u2010Fonsegrives 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