{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:16:52Z","timestamp":1747185412697,"version":"3.40.5"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T00:00:00Z","timestamp":1639353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The US Food and Drug Administration recently defined the clinical term \u201cbacillus Calmette\u2010Gu\u00e9rin\u2010unresponsive non\u2010muscle\u2010invasive bladder cancer\u201d as a disease state resistant to adequate bacillus Calmette\u2010Gu\u00e9rin therapy. There is a significant lack of prognostication for this disease even in patients who have undergone early radical cystectomy. This study aimed to identify the clinical outcomes and prognostic factors in Japanese patients with bacillus Calmette\u2010Gu\u00e9rin\u2010unresponsive non\u2010muscle\u2010invasive bladder cancer who underwent early radical cystectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from a large\u2010scale multicenter retrospective study included 2879 patients with highest\u2010risk or high\u2010risk non\u2010muscle\u2010invasive bladder cancer who received intravesical bacillus Calmette\u2010Gu\u00e9rin induction therapy between January 2000 and December 2019. A total of 141 patients (4.3%) met the criteria for bacillus Calmette\u2010Gu\u00e9rin\u2010unresponsive disease, of whom 47 (33.3%) underwent early radical cystectomy. Prognostic factors for three clinical endpoints, namely, unresectable lesion\u2010free survival, cancer\u2010specific survival, and overall survival, were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The highest\u2010risk status at induction bacillus Calmette\u2010Gu\u00e9rin was associated with short unresectable lesion\u2010free survival (hazard ratio 7.85; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05), cancer\u2010specific survival (hazard ratio 12.24; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05), and overall survival (hazard ratio 9.25; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). Moreover, extravesical tumors (pathological T3 or T4) on the radical cystectomy specimens were associated with poor prognosis and were found at a higher rate in patients with the highest\u2010risk status at induction bacillus Calmette\u2010Gu\u00e9rin than in those with high\u2010risk status (35.7% <jats:italic>vs<\/jats:italic> 21.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The highest\u2010risk status among the pre\u2010bacillus Calmette\u2010Gu\u00e9rin factors was associated with upstaging to extravesical tumors and poor prognosis despite early radical cystectomy procedures. Appropriate decision\u2010making and the correct timing of radical cystectomy are vital to avoid treatment delays and improve outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.14759","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T22:57:51Z","timestamp":1639436271000},"page":"242-249","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prognostication in Japanese patients with bacillus Calmette\u2010Gu\u00e9rin\u2010unresponsive non\u2010muscle\u2010invasive bladder cancer undergoing early radical cystectomy"],"prefix":"10.1111","volume":"29","author":[{"given":"Nobutaka","family":"Nishimura","sequence":"first","affiliation":[{"name":"Department of Urology Nara Medical University Kashihara Nara 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