与前期根治性膀胱切除术 (RC) 相比，对卡介苗 (BCG) 无反应的非肌层浸润性膀胱癌 (NMIBC) 患者的膀胱保留疗法 (BST) 的肿瘤学风险进行量化。预先指定的数据元素是从来自 10 个国际地点的 BCG 无反应 NMIBC 患者的回顾性队列中收集。经机构审查委员会批准后，如果患者患有 BCG 无反应且符合美国食品和药物管理局标准的 NMIBC，则将其纳入研究。肿瘤学结果是在前期 RC 或 BST 后收集的。 BST 方案包括再次切除或仅监测、重复 BCG、膀胱内化疗、全身免疫治疗和临床试验。在 578 名患者中，28% 接受了前期 RC，72% 接受了 BST。中位随访时间（四分位距）为 50（20-69）个月。治疗组之间的无转移生存率、癌症特异性生存率或总生存率没有统计学上的显着差异。在 BST 组中，12 个月和 24 个月时的高级别复发率为 37% 和 52%，12 个月和 24 个月时进展为 MIBC 的比例分别为 7% 和 13%。 BST 组中 31.7% 的患者进行了 RC，13% 的患者发现了淋巴结病变，而前期 RC 中的淋巴结病变率为 4%（P = 0.030）。在选定的患者队列中，初始 BST 提供的生存结果与中期的前期 RC 相当。学期。复发率和进展率随着时间的推移而增加，尤其是接受额外 BST 线治疗的患者。© 2024 作者。 BJU International 约翰·威利 (John Wiley) 出版

To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.