{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T05:58:13Z","timestamp":1764050293106,"version":"3.45.0"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Japan Society for the Promotion of Science and Grants-in-Aid for Scientific Research","award":["25K20053"],"award-info":[{"award-number":["25K20053"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The Vesical Imaging-Reporting and Data System (VI-RADS) provides high diagnostic accuracy for muscle-invasive bladder cancer; however, its prognostic value remains limited. We propose serum cytokeratin 19 fragment (CYFRA 21-1) and tumor contact length (TCL) as complementary prognostic factors. We aimed to construct a composite risk score integrating VI-RADS, CYFRA 21-1, and TCL for prognostic stratification. Methods: We retrospectively analyzed data from 101 patients with bladder cancer (BC) who underwent transurethral resection of bladder tumor (TURBT), magnetic resonance imaging, and postoperative serum CYFRA 21-1 measurement. For each factor, cut-off values were determined using receiver operating characteristic (ROC) analysis; meeting each threshold contributed one point (score range, 0\u20133). Overall survival (OS) was assessed using Kaplan\u2013Meier and Cox regression analyses. Results: ROC analysis identified cut-offs of VI-RADS \u2265 3 (area under the curve [AUC] 0.779), TCL \u2265 40 mm (AUC 0.817), and CYFRA 21-1 \u2265 2.1 ng\/mL (AUC 0.875). Based on these, patients were stratified into low- (0\u20131, n = 81), intermediate- (2, n = 12), and high-risk (3, n = 8) groups with 3-year OS rates of 95.1%, 75.0%, and 25.0%, respectively (p &lt; 0.001). In univariate Cox regression, all factors significantly predicted poor OS: VI-RADS \u2265 3 (hazard ratio [HR], 6.51; p = 0.015), TCL \u2265 40 mm (HR, 8.36; p &lt; 0.001), and CYFRA 21-1 \u2265 2.1 ng\/mL (HR, 14.02; p &lt; 0.001). In multivariate analysis, only CYFRA 21-1 remained independently significant (HR, 11.80; p &lt; 0.001). Conclusions: A composite risk score combining VI-RADS, TCL, and CYFRA 21-1 effectively stratified patients with BC into distinct groups using minimally invasive, peri-TURBT assessments. Prospective multicenter validation is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics15232968","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T10:24:17Z","timestamp":1763979857000},"page":"2968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Composite Risk Score Based on VI-RADS, Tumor Contact Length, and CYFRA 21-1 for Prognostic Stratification in Bladder Cancer"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0570-8173","authenticated-orcid":false,"given":"Shunsuke","family":"Ikuma","sequence":"first","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Akatsuka","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godai","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4556-6601","authenticated-orcid":false,"given":"Hayato","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0787-9321","authenticated-orcid":false,"given":"Yuki","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0088-9324","authenticated-orcid":false,"given":"Go","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4141-9230","authenticated-orcid":false,"given":"Yukihiro","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.eururo.2018.04.029","article-title":"Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting and Data System)","volume":"74","author":"Panebianco","year":"2018","journal-title":"Eur. 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