欧洲泌尿学协会（EAU）指南推荐对非肌层浸润性膀胱癌（NMIBC）的非常高危（VHR）患者进行即刻的根治性膀胱切除术（早期RC），只建议那些拒绝或无法接受根治性膀胱切除术的患者接受卡氏卡介苗（BCG）治疗。为了描述VHR NMIBC（符合EAU标准）患者在接受BCG或早期RC后的肿瘤学预后结果，我们调查了2000年至2020年间被诊断为VHR NMIBC的患者，这些患者来自我们的机构性NMIBC登记处。主要的结果指标是总体生存率（OS）和癌症特异性死亡率（CSM）。次要的结果指标是接受BCG治疗的患者的进展速率和高级别复发率（HGR）。我们发现了235例VHR NMIBC患者，其中157例（67%）接受了BCG治疗，78例（33%）进行了早期RC手术。中位随访时间为52.8个月。BCG组的OS和CSM率分别为80.2%和5.3%，早期RC组的OS和CSM率分别为88.1%和4.9%，两组之间的OS（p = 0.6）和CSM（p = 0.8）没有显著差异。在接受BCG治疗的患者中，5年HGR和进展率分别为41.9%和17.4%，39名患者（25%）在BCG治疗后进行了延迟RC手术。在将接受延迟RC（BCG后）的患者与进行早期RC的患者进行比较时，CSM没有显著差异（p = 0.86）。我们的发现表明，对于VHR NMIBC的选择性患者，BCG可以作为早期RC的合理替代品。我们评估了接受BCG和早期膀胱手术切除的非常高危非肌层浸润性膀胱癌（NMIBC）患者的预后结果，发现在生存率方面没有差异。我们得出结论，对于此类膀胱癌患者，BCG可以作为早期膀胱切除的合理替代选择。版权所有©2023年欧洲泌尿学协会。由Elsevier B.V.出版。保留所有权利。

European Urology Association (EAU) guidelines recommend immediate radical cystectomy (early RC) for patients with very high-risk (VHR) non-muscle invasive bladder cancer (NMIBC), with bacillus Calmette-Guérin (BCG) recommended only for those who refuse or are unfit for RC.To describe oncological outcomes following BCG or early RC in a contemporary cohort of patients with VHR NMIBC (EAU criteria).Patients diagnosed with VHR NMIBC between 2000 and 2020 were identified from our institutional NMIBC registry.The primary outcomes were overall survival (OS) and cancer-specific mortality (CSM). Secondary outcomes were the progression rate and high-grade recurrence (HGR) rate for patients receiving BCG.We identified 235 patients with VHR NMIBC, of whom 157 (67%) received BCG and 78 (33%) underwent early RC. The median follow-up was 52.8 mo. OS and CSM rates were 80.2% and 5.3% in the BCG group, and 88.1% and 4.9% in the early RC group, respectively with no significant difference in OS (p = 0.6) or CSM (p = 0.8) between the two groups. Among the patients treated with BCG, 5-yr HGR and progression rates were 41.9% and 17.4%, respectively; 39 patients (25%) underwent delayed RC after BCG. No significant difference in CSM emerged when comparing patients treated with delayed RC (after BCG) with those undergoing early RC (p = 0.86).Our findings suggest that intravesical BCG can be offered to patients as a resonable alternative to early RC for selected patients with VHR NMIBC.We evaluated outcomes for patients with very high-risk non-muscle-invasive bladder cancer (NMIBC) treated with BCG (bacillus Calmette-Guérin) versus early surgical removal of the bladder and found no differences in survival. We conclude that BCG could be offered to selected patients with this type of bladder cancer as a reasonable alternative to early bladder removal.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.