{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:30:01Z","timestamp":1791811801850,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"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":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate whether longitudinal tumour\u2010informed circulating tumour DNA (ctDNA) testing identifies patients at increased risk of upstaging and recurrence in high\u2010risk non\u2010muscle\u2010invasive bladder cancer (NMIBC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A cohort of 52 patients with high\u2010risk NMIBC underwent serial plasma ctDNA testing using a personalised tumour\u2010informed assay. The ctDNA was obtained at initial presentation and at approximately 3\u2010month surveillance intervals during appropriate routine clinical NMIBC therapy and follow\u2010up. A subset of tumours underwent tumour\u2010normal whole\u2010exome sequencing to evaluate genomic alterations associated with ctDNA detection and clinical progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Circulating tumour DNA was detectable in 17 of 52 patients (33%), including eight of 29 who were Bacillus Calmette\u2013Gu\u00e9rin (BCG)\u2010na\u00efve (28%) and nine of 23 who were BCG\u2010exposed\/BCG\u2010unresponsive patients (39%). Most patients received intravesical therapy, including BCG or salvage intravesical chemotherapy, and a subset underwent radical cystectomy. Clinical upstaging occurred in 10 of 17 ctDNA\u2010positive patients vs five of 35 ctDNA\u2010negative patients (59% vs 14%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). Among the 21 patients undergoing cystectomy, pathological upstaging occurred in seven of nine ctDNA\u2010positive patients and one of 12 ctDNA\u2010negative patients (78% vs 8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). Distant recurrence occurred in three of 17 (18%) ctDNA\u2010positive patients and in none of ctDNA\u2010negative patients.\n                      <jats:italic>TP53<\/jats:italic>\n                      alterations were enriched in ctDNA\u2010positive tumours, whereas fibroblast growth factor receptor (\n                      <jats:italic>FGFR3<\/jats:italic>\n                      ) alterations were more frequent in ctDNA\u2010negative tumours. Limitations include the small cohort and limited follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Longitudinal ctDNA testing in high\u2010risk NMIBC identifies a subgroup with higher risk of clinical and pathological upstaging and distant recurrence, often without corresponding cystoscopic or radiographic evidence. ctDNA\u2010positivity reflects aggressive tumour biology and may help identify patients unlikely to benefit from continued intravesical salvage therapy. These findings support further evaluation of ctDNA as a potential risk stratification tool and motivate prospective studies of ctDNA\u2010guided management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70376","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:37:34Z","timestamp":1782985054000},"page":"491-500","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Longitudinal circulating tumour\n                    <scp>DNA<\/scp>\n                    identifies patients\u00a0at high risk of upstaging and recurrence in non\u2010muscle\u2010invasive bladder cancer"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1486-183X","authenticated-orcid":false,"given":"Can","family":"Aydogdu","sequence":"first","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"},{"name":"Department of Urology LMU University Hospital, Ludwig\u2010Maximilians\u2010University M\u00fcnchen  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean Thomas","family":"McSweeney","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-252X","authenticated-orcid":false,"given":"Gabriela","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeris","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahab Ram","family":"Dewala","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Arya","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikayla","family":"Baer","sequence":"additional","affiliation":[{"name":"Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic  Cleveland OH 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