ArticleBJU international2026
Computed tomography-derived extracellular volume fraction is associated with high-grade recurrence in non-muscle-invasive bladder cancer treated with intravesical gemcitabine and docetaxel.
Article in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate whether extracellular volume (ECV) fraction derived from contrast-enhanced computed tomography (CT) is associated with recurrence risk in patients with treatment-naïve high-risk non-muscle-invasive bladder cancer (HR-NMIBC) receiving intravesical gemcitabine/docetaxel (Gem/Doce) therapy. PATIENTS AND
methodsThis retrospective cohort study, conducted at a tertiary referral centre, included 103 patients with HR-NMIBC treated with intravesical Gem/Doce between 2012 and 2024. All patients underwent pre-resection contrast-enhanced CT with an equilibrium phase (~3 min post-injection). Tumour ECV fraction (%) was calculated using the formula: ECV = (ΔHUtumour/ΔHUaorta) × (1 - haematocrit) × 100, where Δ Hounsfield units (HU) represents the change in attenuation between non-contrast and equilibrium phases. Regions of interest were manually placed in the tumour and abdominal aorta, and haematocrit values obtained within ±10 days were used. Associations between clinical variables, ECV, and recurrence were evaluated using Cox proportional hazards models, with discrimination assessed by Uno's C-statistic.
resultsThe median (interquartile range) follow-up was 17 (10-25) months. High-grade recurrence-free survival (HG-RFS) was 76% at 12 months and 69% at 24 months. CT-derived ECV was the only variable significantly associated with HG-RFS (hazard ratio 1.05, 95% confidence interval 1.03-1.08), demonstrating strong discrimination (C-statistic, 0.81; P < 0.01). A 15% threshold offered the best sensitivity-specificity trade-off (~70% each) for predicting HG-RFS at 12 and 24 months. Patients with ECV ≤15% had markedly better HG-RFS than those with ECV >15% at 24 months (88% vs 41%).
conclusionsThe CT-derived ECV is a practical, first-of-its-kind imaging biomarker associated with recurrence risk and useful for risk stratification in patients with HR-NMIBC treated with intravesical Gem/Doce, a regimen increasingly used in the setting of global Bacillus Calmette-Guérin shortages and intolerance. ECV can be rapidly quantified from routine contrast-enhanced CT using standard picture archiving and communication system (PACS) tools, without additional imaging or proprietary software, making it a feasible metric for integration into risk-adapted management pending large-scale validation with extended follow-up.
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