EORTC Bladder Cancer Risk
Calculate recurrence and progression risk for non-muscle invasive bladder cancer using the validated EORTC scoring system. Six factors guide treatment decisions.
Why This Health Metric Matters
Why: Risk stratification guides BCG vs chemotherapy vs cystectomy decisions. Progression risk (invasion to muscle) is distinct from recurrence risk.
How: The EORTC calculator assigns points for six prognostic factors: tumor number, size, prior recurrence, T stage, CIS, and grade. Scores map to 1-year and 5-year probabilities.
- ●NMIBC represents ~75% of newly diagnosed bladder cancers
- ●CIS adds 6 points to progression score
- ●BCG maintenance for 3 years reduces recurrence ~35%
🩺 Sample Clinical Scenarios — Click to Load
Tumor Characteristics
Enter tumor characteristics from TURBT pathology and clinical staging
⚠️For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
NMIBC represents ~75% of newly diagnosed bladder cancers
— EAU
Concurrent CIS adds 6 points to progression score
— EORTC
BCG maintenance 3 years reduces recurrence ~35% in high-risk
— SWOG 8507
📋 Key Takeaways
- • EORTC scores stratify NMIBC into low, intermediate, and high-risk groups for recurrence and progression
- • Six factors contribute: tumor number, size, prior recurrence, T stage, CIS, and grade
- • Risk stratification guides BCG vs chemotherapy vs cystectomy decisions
- • Progression risk (invasion to muscle) is distinct from recurrence risk
💡 Did You Know?
📖 How the EORTC Calculator Works
The EORTC calculator assigns points for six prognostic factors, generating separate scores for recurrence (0-17) and progression (0-23) risk.
Step 1: Collect Tumor Data
Obtain pathology from TURBT including stage, grade, presence of CIS, tumor number and size.
Step 2: Assign Factor Points
Each of the 6 factors contributes different points to recurrence and progression scores. CIS contributes the most to progression (6 pts).
Step 3: Determine Risk Groups
Scores are categorized into low, intermediate-low, intermediate-high, and high risk. EORTC tables provide 1-year and 5-year probabilities.
🎯 Expert Tips for NMIBC Management
💡 Quality TURBT
Complete resection with visible muscle in specimen. Re-TURBT mandatory for T1, high-grade, or incomplete resection.
💡 BCG Best Practices
Delay BCG at least 2 weeks after TURBT. Induction: 6 weekly instillations. Maintenance: 3-year schedule for high-risk.
💡 Single Instillation
Immediate post-operative chemotherapy (within 24h) for all initial tumors—reduces recurrence by 39% in low-risk.
💡 When to Consider Cystectomy
Very high-risk NMIBC, BCG-unresponsive disease, T1G3 with CIS, or variant histology.
⚖️ EORTC vs. Alternative Risk Tools
| Feature | EORTC Calculator | CUETO Model | Manual Lookup |
|---|---|---|---|
| Recurrence prediction | ✅ | ✅ | ⚠️ |
| Progression prediction | ✅ | ✅ | ⚠️ |
| BCG-treated patients | ⚠️ May overestimate | ✅ More accurate | ❌ |
| 1-year & 5-year estimates | ✅ | ✅ | ❌ |
| Treatment recommendations | ✅ | ❌ | ❌ |
| Export & share results | ✅ | ❌ | ❌ |
❓ Frequently Asked Questions
What is the difference between recurrence and progression?
Recurrence refers to tumor reappearance after complete resection, often at the same stage. Progression means advancement to muscle-invasive disease, which has more serious implications for survival.
Why is CIS such an important risk factor?
Carcinoma in situ (CIS) is a flat, high-grade lesion with high malignant potential. Its presence significantly increases progression risk. CIS requires aggressive treatment, typically BCG induction and maintenance.
What is the role of BCG therapy?
BCG (Bacillus Calmette-Guérin) is an immunotherapy that reduces recurrence and progression in intermediate and high-risk NMIBC. Maintenance BCG for 1-3 years improves outcomes.
When should cystectomy be considered?
Radical cystectomy should be considered for very high-risk NMIBC, BCG-unresponsive disease, T1G3 with CIS, and variant histology. It offers the best chance of cure when bladder-sparing is no longer appropriate.
How often should surveillance cystoscopy be performed?
Low-risk: Cystoscopy at 3 months, then annually for 5 years. Intermediate-risk: Every 3-6 months for 2 years, then annually. High-risk: Every 3 months for 2 years, every 6 months for years 3-5.
What are the limitations of the EORTC model?
The EORTC model was developed before widespread use of re-TURBT and BCG maintenance. It may overestimate risk in patients receiving optimal contemporary treatment. The CUETO model may be more accurate for BCG-treated patients.
What is re-TURBT and when is it needed?
Re-staging TURBT (re-TURBT) is performed 2-6 weeks after initial resection. It is mandatory for T1 tumors, high-grade disease, or incomplete initial resection to ensure accurate staging.
Can molecular markers improve risk stratification?
Emerging molecular markers (e.g., FGFR3, TERT mutations) may improve risk stratification beyond clinical factors. Research is ongoing.
📊 NMIBC by the Numbers
📚 Official Data Sources
⚠️ Disclaimer: This calculator is for educational purposes only. It should not replace professional medical advice. Treatment decisions should be made by qualified urologists based on individual circumstances and current EAU/AUA guidelines. The EORTC risk tables are based on historical data and may not reflect outcomes with contemporary treatment.