{
  "abstract": "Bacillus Calmette-Guerin (BCG)-unresponsive high-risk non-muscle-invasive bladder cancer (NMIBC) remains a challenging disease state in which radical cystectomy (RC) provides the most reliable oncologic control, while an expanding range of bladder-preserving therapies offers alternatives for patients who decline or are unfit for surgery. We critically reviewed PubMed/MEDLINE, international guidelines, pivotal and late-phase trials, long-term follow-up studies, regulatory summaries, systematic reviews, and multicenter real-world studies through 30 September 2026, prioritizing evidence relevant to patient selection, response durability, progression risk, salvage RC, treatment burden, and patient-reported outcomes. Pembrolizumab, nadofaragene firadenovec, nogapendekin alfa inbakicept plus BCG, the gemcitabine intravesical system (TAR-200), oncolytic viral approaches, FGFR-directed therapy, and sequential intravesical gemcitabine/docetaxel have broadened treatment options in this setting. However, cross-trial comparisons based on a single 3- or 6-month complete response are potentially misleading because disease phenotype, response definitions, surveillance intensity, biopsy requirements, treatment duration, and failure management differ substantially across studies; for most platforms, cross-trial efficacy estimates should therefore be interpreted descriptively rather than as head-to-head comparisons. We propose an author-derived, non-validated hierarchical framework in which clinically meaningful bladder preservation integrates phenotype-matched early tumor clearance, 12- to 24-month response durability, high-grade recurrence-free survival, freedom from muscle-invasive or metastatic progression, the timing and pathologic outcomes of subsequent RC, and treatment burden. This framework is intended to organize clinical interpretation rather than function as a validated score, guideline, or consensus recommendation. Persistent or recurrent high-grade disease, particularly T1 recurrence or suspected progression, should prompt restaging and renewed discussion of RC. Bladder preservation should thus be regarded as a time-limited, closely monitored management strategy with explicit entry criteria and stopping rules. Its success should be defined by durable high-grade disease control without compromising the opportunity for curative salvage RC, rather than by preservation of the bladder alone.",
  "abstract_shown": true,
  "affiliations": [
    "Second Department of Urology, The First Affiliated Hospital of Kunming Medical University"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Chaohu Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Botao Xie"
    },
    {
      "affs": [
        0
      ],
      "name": "Cheng Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Peng Gu"
    },
    {
      "affs": [
        0
      ],
      "name": "Xinan Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b1qtsbmpyvzc9.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1983996",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736040/",
  "id": "b1qtsbmpyvzc9",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1983996/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2746|Bladder and Urothelial Cancer Treatments"
    ]
  ],
  "openalex": "W7223177218",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1983996/pdf",
  "pmcid": "PMC13736040",
  "pmid": "42991509",
  "published": "2026-10-22",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/b1qtsbmpyvzc9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.1983996",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1983996/full"
    },
    {
      "first_seen": "2026-11-09T12:21:35Z",
      "native_id": "PMC13736040",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.1983996"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Bladder and Urothelial Cancer Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Defining safe bladder preservation in BCG-unresponsive high-risk non-muscle-invasive bladder cancer: beyond complete response",
  "title_text": "Defining safe bladder preservation in BCG-unresponsive high-risk non-muscle-invasive bladder cancer: beyond complete response",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:35Z",
  "url": "https://research.draconitic.com/paper/b1qtsbmpyvzc9",
  "venue": "Frontiers in Immunology",
  "versions": []
}