# EORTC Bladder Cancer Recurrence and Progression Calculator

EORTC Bladder Cancer Recurrence and Progression Calculator enables you to find the probability of the recurrence and progression of a non-muscle invasive bladder cancer over one and five years. It takes into consideration six parameters concerning the medical history of the patient, and helps you to choose the appropriate treatment options.

## About bladder cancer

**Bladder cancer is the most common urinary tract malignancy**. It usually affects people over 60 years old and more men than women. Smoking is the biggest risk factor for developing this cancer (smoking of course causes other cancers, such as lung cancer and kidney cancer). The most typical symptom is painless hematuria (blood in the urine). **Remember! If haematuria has been found, always search for bladder (or kidney) cancer!**

At the time of diagnosis, around 75% of the patients have **non-muscle invasive bladder cancer (NMIBC)**, while the remaining 25% already have an advanced disease. Patients with NMIBC generally have good survival rate, but the condition has a significant potential for **recurrence** of the tumor in the bladder, which may even **progress** into a more advanced stage of the disease.

## Bladder cancer recurrence and progression probability calculator

The treatment of patients with non-muscle invasive bladder cancer should be based on their prognosis, which includes a prognosis of the tumor's recurrence and progression. This **EORTC bladder cancer recurrence and progression calculator** is a tool that predicts the probability of recurrence and progression and thus proposes an appropriate management of the patients with non-muscle invasive bladder cancer. This calculator was built using the recommendations set out by the European Association of Urology in their guidelines on non-muscle invasive bladder cancer. This process was first described using the analysis of almost 2600 patients by Sylvester et al. in an article titled Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables. This bladder cancer prognosis calculator is a kind of scoring system which is based on six clinical and pathological factors:

- number of tumors,
- tumor size (diameter of the biggest tumor),
- prior bladder cancer recurrence rate,
- stage of the disease (T category),
- carcinoma in situ (in bladder cancer CIS is always high grade, requires immediate treatment and worsens the prognosis),
- tumor grade.

For each of these variables the patient receives a score from 0 to 6 (for both the risk of recurrence and progression). The details are presented in the table:

Factor | Recurrence points | Progression points | |
---|---|---|---|

Number of tumors | single | 0 | 0 |

2-7 | 3 | 3 | |

8 | 6 | 3 | |

Tumor diameter | <3cm | 0 | 0 |

>3cm | 3 | 3 | |

Prior recurrence rate | primary | 0 | 0 |

<1 rec/year | 2 | 2 | |

>1 rec/year | 4 | 2 | |

Stage | Ta | 0 | 0 |

T1 | 1 | 4 | |

Concomitant CIS | No | 0 | 0 |

Yes | 1 | 6 | |

Grade | G1 | 0 | 0 |

G2 | 1 | 0 | |

G3 | 2 | 5 | |

Total Score | 0-17 | 0-23 |

After calculating the recurrence points and progression points, they are transfered into percentage of risk according to the tables below:

Recurrence points | Risk of recurrence at 1 year | Risk of recurrence at 5 years |
---|---|---|

0 | 15% | 31% |

1-4 | 24% | 46% |

5-9 | 38% | 62% |

10-17 | 61% | 78% |

Progression points | Risk of progression at 1 year | Risk of progression at 5 years |
---|---|---|

0 | 0.2% | 0.8% |

2-6 | 1% | 6% |

7-13 | 5% | 17% |

14-23 | 17% | 45% |

The probabilities of recurrence and progression at one year range from 15% to 61% and from less than 1% to 17%, respectively. At the five year mark, the probabilities of recurrence and progression range from 31% to 78% and from less than 1% to 45%. By using the data attached to a specific patient, the urologist can discuss the different therapeutic options with the patient to determine which is the most appropriate treatment and what frequency of follow-up is required.

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