EORTC NMIBC Risk Stratification
Select pathological and clinical features to calculate the EORTC recurrence and progression scores for non–muscle-invasive bladder cancer (NMIBC).
Recurrence risk
Low risk of recurrence
Score: 0 points · 1-year recurrence risk 15% · 5-year recurrence risk 31%
Annual cystoscopy typically adequate; consider intravesical chemotherapy for intermediate factors.
Progression risk
Very low risk of progression
Score: 0 points · 1-year progression risk 0.2% · 5-year progression risk 0.8%
Routine surveillance is appropriate. BCG generally not required unless other features emerge.
How to Use This Calculator
Confirm NMIBC pathology
Ensure tumour stage is Ta or T1 and grade is classified using the WHO 1973 system. Record number, size, and presence of concomitant CIS.
Enter risk factors
Choose the appropriate category for tumour count, size, prior recurrence rate, T category, CIS status, and grade based on surgical pathology and history.
Apply risk estimates to management
Use recurrence and progression probabilities to guide adjuvant therapy, surveillance intervals, and discussions about BCG or early cystectomy.
Formula
Recurrence score = Points from tumour number (0/3/6) + size (0/3) + recurrence rate (0/2/4) + T category (0/1) + CIS (0/1) + grade (0/2/5)
Progression score = Points from tumour number (0/3/3) + size (0/3) + recurrence rate (0/2/2) + T category (0/4) + CIS (0/6) + grade (0/1/3)
Risk percentages derived from EORTC trials (Sylvester et al., Eur Urol 2006) for patients treated with TURBT ± intravesical chemotherapy.
Full Description
The EORTC risk tables stratify NMIBC patients by recurrence and progression risk using six clinicopathologic factors. They inform surveillance schedules and indicate which patients benefit most from intravesical therapy (e.g., BCG with maintenance). While invaluable, the tables may overestimate risk in patients receiving modern maintenance BCG; incorporate clinical judgement and patient preferences when planning treatment.
Frequently Asked Questions
Does this apply after BCG therapy?
The original EORTC cohort had limited maintenance BCG, so risks may be overestimated in patients receiving modern BCG protocols. Use caution and consider CUETO tables for BCG-treated patients.
What if pathology uses WHO 2004/2016 grading?
Map low-grade to G1, high-grade to G3. G2 often encompasses intermediate features; consult your pathologist for concordance with WHO 1973 grading.
How should I manage very high risk patients?
Offer BCG with maintenance but discuss early radical cystectomy, especially for T1 high-grade tumours with CIS or multifocal disease. Engage a multidisciplinary team.
Can I use these scores for variant histology?
Variant histologies (micropapillary, nested) were not included in the EORTC studies. They often warrant more aggressive management than suggested by the score.