π©Ί EORTC Bladder Cancer Risk Calculator
Recurrence and progression odds from six pathology factors.
For informational purposes only, not medical advice. Consult a healthcare professional.
The EORTC tables turn six pathology facts into two scores: recurrence risk (0 to 17) and progression risk (0 to 23), each mapped to 1-year and 5-year probabilities. A single small primary Ta G1 tumor scores 0 and 0: 15% recurrence at 1 year, 31% at 5 years, with progression under 1%. Enter the pathology details for both scores.
How to Use This Calculator
Every input comes from the TURBT pathology report and the cystoscopy history. This tool implements the Sylvester 2006 EORTC tables for non-muscle-invasive bladder cancer (Ta, T1, CIS).
Enter the tumor count, the largest diameter, and the prior recurrence rate (primary vs recurrences per year). Multiplicity and size are the strongest recurrence drivers.
Enter the T category (Ta vs T1), whether concomitant CIS is present, and the 1973 WHO grade (G1-G3). CIS and G3 dominate the progression score.
Read both scores with their 1-year and 5-year probabilities and risk groups. Recurrence and progression are separate answers; a tumor can recur often without ever progressing.
The EORTC Scoring
Sylvester and colleagues built these tables from 2,596 patients across seven EORTC trials, and the weights encode hard-won clinical lessons. Notice that grade G2 adds nothing to progression while G3 adds 5: the biology jumps at high grade, not gradually. CIS adds 6 to progression but only 1 to recurrence, because CIS rarely stays quiet. T1 adds 4 to progression versus 1 to recurrence: invasion into lamina propria is the hinge of the whole disease. The probability tables then translate each score band into observed 1-year and 5-year rates from that cohort.
Worked Example
Best case: single tumor, under 3 cm, primary, Ta, no CIS, G1. Recurrence: 0+0+0+0+0+0 = 0, giving 15% at 1 year and 31% at 5 years, low risk. Progression: 0, giving 0.2% and 0.8%. Worst-ish case: 2 to 7 tumors (3/3), 3+ cm (3/3), more than 1 recurrence per year (4/2), T1 (1/4), CIS present (1/6), G3 (2/5). Recurrence: 3+3+4+1+1+2 = 14, high risk: 61% at 1 year, 78% at 5 years. Progression: 3+3+2+4+6+5 = 23, the maximum: 17% at 1 year, 45% at 5 years. The same patient gets two very different numbers because recurrence and progression are different biologies, and treatment (like BCG) targets them differently.
Risk Groups and What Changes
| Group | Recurrence 1yr/5yr | Progression 1yr/5yr | Typical management |
|---|---|---|---|
| Low | 15% / 31% | 0.2% / 0.8% | Single post-TUR chemo instillation, relaxed surveillance |
| Intermediate | 24-38% / 46-62% | 1-5% / 6-17% | Adjuvant intravesical chemo or BCG, regular cystoscopy |
| High | 61% / 78% | 17% / 45% | Full BCG induction + maintenance; cystectomy discussed for highest risk |
The tables do more than predict; they set the surveillance schedule. Low-risk patients can space cystoscopies out, while high-risk patients get scoped every 3 months for years, because catching progression early is the whole game. The 3-month post-TUR cystoscopy is the single most important prognostic check regardless of score: a recurrence found there upgrades everything. BCG immunotherapy is the standard for intermediate and high risk, and its benefit is largest exactly where the scores are worst. For related urologic risk tools, our blood count converter helps read the labs around treatment, and our GFR calculator matters because BCG and chemotherapy dosing both consider kidney function.
What the Tables Do Not Cover
The EORTC tables predate some modern practice: they were built before routine re-resection for T1 disease and before the 2004/2016 WHO grading shift (low/high grade) fully replaced G1-G3, though the mapping is standard. They do not account for BCG treatment effect, variant histology, lymphovascular invasion, or molecular markers, all of which modify real risk. The newer EAU risk groups and the CUETO tables (built on BCG-treated patients) complement rather than replace EORTC. And these are group probabilities from a trial cohort, not personal prophecies: a 78% 5-year recurrence rate means most recur, but more than one in five do not. Your urologist folds the score into the full picture, including what the bladder actually looks like at each cystoscopy.
A Note on the Numbers' Gravity
A 45% 5-year progression probability is a frightening number to read on a screen. Remember what it is: the observed rate in a historical cohort with these exact features, used to justify aggressive treatment that itself lowers the risk. High-risk NMIBC caught and treated per guidelines has far better outcomes than the raw table suggests, because the table describes the disease while treatment changes its course. The score's job is to make sure high-risk disease gets high-intensity care, not to deliver a verdict. Bring the numbers to your urologist and ask what they change about your specific plan; that conversation is the point of the calculator.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the EORTC bladder cancer risk calculator?
A scoring system from Sylvester et al. (2006) that predicts recurrence and progression in non-muscle-invasive bladder cancer from six factors: tumor number, size, prior recurrence rate, T category, CIS, and grade. It outputs 1-year and 5-year probabilities.
What is the difference between recurrence and progression?
Recurrence means new tumors appearing in the bladder; progression means the disease advancing to muscle-invasive or metastatic stages. A tumor can recur many times without progressing, and the EORTC scores the two separately because different factors drive them.
What EORTC score is high risk?
Recurrence score 10-17 and progression score 14-23 are high risk: 61%/78% recurrence and 17%/45% progression at 1/5 years. These patients typically receive full BCG therapy and intensive surveillance.
How accurate are the EORTC tables?
They were derived from 2,596 trial patients and validated in multiple cohorts with reasonable calibration, though they tend to overestimate risk in modern BCG-treated populations. They remain the most widely used NMIBC risk tool worldwide.
Does BCG treatment change my EORTC risk?
Yes, favorably, but the tables were built largely on pre-BCG-era data and do not subtract the treatment effect. The CUETO tables were built specifically for BCG-treated patients and give lower estimates; urologists consider both.
What does concomitant CIS add to the score?
1 point for recurrence but 6 for progression, the single largest progression weight. CIS is flat, high-grade disease that signals an unstable urothelium, and its presence pushes management toward BCG or cystectomy.
What is the 3-month cystoscopy and why does it matter?
The first surveillance cystoscopy 3 months after TURBT. Finding a recurrence there is the strongest predictor of future recurrence and progression, stronger than most table factors, and it typically escalates treatment.
Do the tables apply to muscle-invasive bladder cancer?
No. They cover Ta, T1, and CIS only (non-muscle-invasive). Muscle-invasive disease (T2+) follows completely different staging, risk assessment, and treatment pathways.
What is the difference between EORTC and CUETO tables?
EORTC (Sylvester 2006) used mostly non-BCG trial patients; CUETO (Fernandez-Gomez 2009) used BCG-treated patients and generally predicts lower recurrence. Many urologists check both and treat to the higher concern.
Should I make treatment decisions from this calculator?
No. It is an educational implementation of a clinical tool. Real decisions fold in re-resection findings, variant histology, your fitness for BCG or surgery, and your urologist's judgment. Bring the score to your appointment as a discussion aid.