{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:56:57Z","timestamp":1786114617094,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"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":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To report long\u2010term oncological outcomes of patients with high\u2010risk non\u2010muscle\u2010invasive bladder cancer (HR\u2010NMIBC) undergoing bladder\u2010sparing therapy (BST) after bacillus Calmette\u2013Gu\u00e9rin (BCG) failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients with HR\u2010NMIBC treated from 2000 to 2025 with intravesical therapies after BCG failure, all of whom received salvage gemcitabine\/docetaxel (Gem\/Doce). Subsequent BST included valrubicin\/docetaxel, sequential doxorubicin\/gemcitabine alternating with mitomycin\u2010C\/docetaxel, and gemcitabine\/cabazitaxel with pembrolizumab. Kaplan\u2013Meier analysis estimated recurrence\u2010free survival (RFS), progression\u2010free survival (PFS), cystectomy\u2010free survival (CFS), and cancer\u2010specific survival (CSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 85 patients with HR\u2010NMIBC were included of whom 38 (45%) were BCG\u2010unresponsive. The median (interquartile range) follow\u2010up was 86\u2009(43\u2013108)\u2009months from induction Gem\/Doce. Following Gem\/Doce initiation, RFS did not significantly decline with each successive line of salvage therapy: among patients treated with first (Gem\/Doce), second, and third line salvage therapy, the 2\u2010year RFS was 47%, 43%, and 39%, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.68). Overall, the PFS at 5\u2009years was 81% (95% confidence interval [CI] 69\u201388%). PFS did not significantly decline with each successive salvage line of therapy: among patients treated with first (Gem\/Doce), second, and third line salvage therapy, the 2\u2010year PFS was 91%, 88%, and 93%, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.98). CFS and CSS were 74% (95% CI 62\u201383%) and 88% (95% CI 79\u201394%) at 5\u2009years, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multi\u2010line BST is feasible and can yield durable bladder preservation and oncological control in select patients with HR\u2010NMIBC following BCG failure. Progression\u2010free outcomes remained favourable across successive lines of salvage therapy. These findings support the role of longitudinal BST as an alternative to radical cystectomy in carefully and appropriately selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70044","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T07:19:47Z","timestamp":1761117587000},"page":"339-347","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long\u2010term outcomes of a cascading salvage strategy for high\u2010risk non\u2010muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"137","author":[{"given":"Ian M.","family":"McElree","sequence":"first","affiliation":[{"name":"Department of Urology Vanderbilt University Medical Center  Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan L.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Urology University of Iowa  Iowa City IA 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