EORTC Bladder Cancer Risk Calculator (NMIBC)

It is a scoring system published by Sylvester and colleagues in 2006 that estimates the chance of tumor recurrence and of progression to muscle-invasive disease in non-muscle-invasive bladder cancer (stages Ta and T1). It was built from the individual data of 2,596 patients in seven EORTC clinical trials conducted between 1979 and 1989. Six routine clinical and pathological factors are each assigned points, producing a recurrence score from 0 to 17 and a progression score from 0 to 23, which are then converted into 1-year and 5-year probabilities using the published risk tables.

Number of tumors (single 0, 2 to 7 +3, 8 or more +6 recurrence / +3 progression); tumor diameter (under 3 cm 0, 3 cm or more +3); prior recurrence rate (primary tumor 0, up to 1 recurrence per year +2, more than 1 per year +4 recurrence / +2 progression); T category (Ta 0, T1 +1 recurrence / +4 progression); concomitant carcinoma in situ (no 0, yes +1 recurrence / +6 progression); and grade using the 1973 WHO system (G1 0, G2 +1 recurrence and +0 progression, G3 +2 recurrence / +5 progression).

Each score falls into a published probability band. For recurrence: score 0 means about 15% at 1 year and 31% at 5 years (low risk); 1 to 4 means 24% and 46%; 5 to 9 means 38% and 62% (intermediate risk); 10 to 17 means 61% and 78% (high risk). For progression: score 0 means 0.2% at 1 year and 0.8% at 5 years (low risk); 2 to 6 means 1% and 6%; 7 to 13 means 5% and 17% (intermediate risk); 14 to 23 means 17% and 45% (high risk). Each figure is the observed rate in the original EORTC cohort, with its 95% confidence interval shown on this page.

Because of how the points are weighted. Grade G2 adds 1 point to the recurrence score but 0 points to the progression score, and every other factor that contributes to progression adds at least 2 points. The reachable progression scores are therefore 0, then 2 through 21, then 23. A score of 1 (or 22) simply cannot occur, which is why the published progression bands start at 2 to 6.

No. Recurrence means a new tumor appearing in the bladder lining; progression means the disease advancing to muscle-invasive stage (T2 or higher) or to a higher grade. They are scored separately because different factors drive them: tumor number, size, and prior recurrence history dominate recurrence risk, while T1 stage, concomitant CIS, and grade G3 dominate progression risk. A patient can have a high recurrence score with a low progression score, and vice versa.

Only with caution. The original cohort was treated between 1979 and 1989: 21% received no intravesical therapy at all and only 7% received BCG, given as induction without maintenance. External validations, including Fernandez-Gomez and colleagues in 2011, found that the EORTC tables overestimate both recurrence and progression in patients treated with modern BCG schedules. For BCG-treated patients the Spanish CUETO scoring model was developed specifically, and the 2022 EAU guidelines strongly recommend the 2021 EAU NMIBC risk calculator for individual progression prediction.

The EORTC tables (2006) use six clinical and pathological factors and were derived from a mixed-treatment historical cohort; the EAU still endorses them for recurrence prediction. The CUETO model (2009) was built from 1,062 patients treated with BCG and uses seven factors, adding patient age and sex, with scores from 0 to 16 for recurrence and 0 to 14 for progression. They answer slightly different questions, so the choice depends on the treatment context.

No. It is an educational tool that reproduces published population-level risk tables. It cannot account for your full clinical picture, modern treatment effects, or pathology details, and it must not be used to choose treatment or follow-up. Bring the result to your urologist or uro-oncologist and let them interpret it in context.