{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:22:14Z","timestamp":1790922134660,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"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":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To validate International Bladder Cancer Group (IBCG) definitions of Bacillus Calmette\u2010Gu\u00e9rin (BCG)\u2010unresponsive and BCG\u2010exposed non\u2010muscle\u2010invasive bladder cancer (NMIBC) and assess prognostic heterogeneity across various BCG\u2010failure types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>From a multicentre international cohort of 3806 BCG\u2010treated patients, 591 who developed high\u2010grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression\u2010free survival (PFS) was the primary endpoint; cancer\u2010specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing\u2010risk models and multivariable Cox regression were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with BCG\u2010unresponsive and BCG\u2010exposed disease showed similar PFS, CSM, and OM (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). When stratified into five subgroups, prognosis varied: 5\u2010year progression rates were 29% for BCG\u2010unresponsive, 32.5% for late relapse (between 6 and 24\u2009months) after adequate BCG, 30% for BCG\u2010exposed with inadequate BCG (&lt;24\u2009months from induction), 6.2% for BCG\u2010resistant, and 14% for very late relapse (&gt;24\u2009months since last BCG) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). In multivariable analysis, BCG\u2010exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33\u20138.84), late relapse (sHR 3.74, 95% CI 1.59\u20138.78), and BCG\u2010unresponsive (sHR 2.34, 95% CI 1.00\u20135.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Under IBCG definitions, BCG\u2010unresponsive and BCG\u2010exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG\u2010unresponsive, and very late relapses conferring better prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70231","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T06:46:48Z","timestamp":1773989208000},"page":"1076-1087","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Refining\n                    <scp>BCG<\/scp>\n                    \u2010failure classifications in non\u2010muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4344-0191","authenticated-orcid":false,"given":"Aleksander","family":"\u015alusarczyk","sequence":"first","affiliation":[{"name":"Department of General, Oncological and Functional Urology Medical University of Warsaw  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Scilipoti","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\/0000-0001-7011-0537","authenticated-orcid":false,"given":"Roberto","family":"Contieri","sequence":"additional","affiliation":[{"name":"Department of Urology, National Cancer Institute IRCCS Fondazione G. Pascale  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Krajewski","sequence":"additional","affiliation":[{"name":"Department of Urology and Oncologic Urology Wroc\u0142aw Medical University  Wroc\u0142aw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-5553","authenticated-orcid":false,"given":"Francesco","family":"Claps","sequence":"additional","affiliation":[{"name":"Oncological Urology Veneto Institute of Oncology IRCCS  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4176-8174","authenticated-orcid":false,"given":"Jos\u00e9 Daniel","family":"Subiela","sequence":"additional","affiliation":[{"name":"Department of Urology, Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Universitario Ram\u00f3n y Cajal Universidad de Alcal\u00e1  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3317-6427","authenticated-orcid":false,"given":"Laura S.","family":"Mertens","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6147-6569","authenticated-orcid":false,"given":"Keiichiro","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Urology The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Grobet\u2010Jeandin","sequence":"additional","affiliation":[{"name":"Division of Urology Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Ca\u00f1o","family":"Velasco","sequence":"additional","affiliation":[{"name":"Department of Urology Cl\u00ednica Universidad de Navarra, Cancer Center  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9499-0169","authenticated-orcid":false,"given":"Karl","family":"Tully","sequence":"additional","affiliation":[{"name":"Department of Urology and Neurourology, Marien Hospital Herne Ruhr\u2010University Bochum  Herne Germany"}],"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":"Pedro Del Olmo","family":"Duran","sequence":"additional","affiliation":[{"name":"Department of Urology, Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Universitario Ram\u00f3n y Cajal Universidad de Alcal\u00e1  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso Lafuente","family":"Puentedura","sequence":"additional","affiliation":[{"name":"Department of Urology Gregorio Mara\u00f1\u00f3n University Hospital  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee A. G.","family":"Lijnen","sequence":"additional","affiliation":[{"name":"Department of Urology Netherlands Cancer Institute  Amsterdam The Netherlands"}],"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"}]},{"given":"Gautier","family":"Marcq","sequence":"additional","affiliation":[{"name":"Department of Urology Claude Huriez Hospital, CHU Lille  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9070-5706","authenticated-orcid":false,"given":"Andrea","family":"Mari","sequence":"additional","affiliation":[{"name":"Department of Urology, Careggi Hospital University of Florence  Florence 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