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Clinical calculator summary

EAU 2021 NMIBC Prognostic Factor Risk Groups

Source-locked implementation of Sylvester et al., Eur Urol 2021;79:480-488 (PMID 33419683), retained as the 2021 EAU NMIBC scoring model in the 2026 guideline.

Evidence-based context for fast calculator use

Purpose:
WHO 2004/2016 or WHO 1973 progression-risk grouping after adequate TURBT.
Population:
patients with non-muscle-invasive or urothelial cancer in the recurrence/progression setting described by the model
Factors:
Pathologic stage, Reported WHO grade, CIS context, Maximum papillary tumor diameter, Papillary tumor multiplicity, Presentation, Age at risk assignment, Urothelial subtype
Reference:
https://doi.org/10.1016/j.eururo.2020.12.033
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EAU 2021 NMIBC Prognostic Factor Risk Groups

years

Age above 70 years is a source-defined factor.

Clinical Context & Background

Primary Source Evidence-locked implementation of Sylvester et al., Eur Urol 2021;79:480-488 (PMID 33419683), retained as the 2021 EAU NMIBC scoring model in the 2026 guideline.
The core coefficients apply to primary Ta/T1 urothelial NMIBC after adequate diagnostic TURBT, before adjuvant therapy, and predict progression to muscle-invasive disease. The derivation excluded patients receiving immediate BCG. Literature-based EAU extensions are labeled separately for primary pure bladder CIS, prostatic urethral CIS, lymphovascular invasion, specified aggressive urothelial subtypes, and recurrent tumors.
WHO 2004/2016 and WHO 1973 are separate source pathways. G2 is preserved only in the WHO 1973 pathway; this route never converts grades. Source-listed very-high-risk subtype selection is limited to pure micropapillary, sarcomatoid, nested, plasmacytoid, or neuroendocrine subtype as applicable. Other or unresolved variants require specialist interpretation.
The output is a source-defined progression-risk group, not recurrence probability or a treatment recommendation. It does not combine EAU with EORTC or CUETO and does not calculate a patient-specific probability. Contemporary BCG-treated cohorts may show lower progression than the original model estimates.
Primary Source Evidencehttps://doi.org/10.1016/j.eururo.2020.12.033
Formula Logic
EAU 2021 weighted progression score using one WHO grade system, followed by source-table composition parity and separately labeled literature extensions.

Reference Data

PathwayLowIntermediateHighVery high
WHO 2004/20160-8085-150165-305315-435
WHO 19730-5258-133142-233242-317
Literature extensionsRecurrent core-low raisedRecurrent minimumPrimary pure bladder CISProstatic urethral CIS / LVI / listed subtype

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use EAU 2021 NMIBC Prognostic Factor Risk Groups when wHO 2004/2016 or WHO 1973 progression-risk grouping after adequate TURBT.
  • Confirm that the patient, diagnosis, disease phase, and available inputs match the cited model before calculation.

How To Interpret

  • Interpret the displayed result using the calculator-specific formula and reference table, spanning WHO 2004/2016 through Literature extensions.
  • A boundary result should prompt input verification and clinical review rather than false precision.

What To Do Next

  • Confirm stage, grade, CIS, tumor number and size, prior recurrence, BCG exposure, pathology review, and guideline risk group.
  • Document the inputs, result, timing, and clinical context so the assessment can be reproduced.

Limitations

  • Historical EORTC, CUETO, and contemporary EAU groups use different populations and should not be interchanged.
  • The result supports clinician judgment and does not independently determine treatment.

Validated Population

patients with non-muscle-invasive or urothelial cancer in the recurrence/progression setting described by the model

How to apply this result

For a representative case, verify Pathologic stage, Reported WHO grade, CIS context, calculate the result, and confirm that its classification matches the highlighted reference band before continuing the disease-specific pathway.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed cases passed through visible production controls below and at the exact 3 cm boundary and through the prostatic-urethral CIS literature override.
    • The former override contradiction was absent: the interpretation, Source row, and Controlling factor consistently identified CIS in the prostatic urethra rather than pure bladder CIS.
    • No unexpected N/A, stale control, literal undefined/null value, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/bladder-cancer-eau-nmibc-risk-2021-2026-08-03.json.

  2. : Local browser remediation verified; production retest pending

    • Corrected the null-core-score presentation so prostatic-urethral CIS, lymphovascular-invasion, and listed-subtype overrides use their own controlling factor in both the interpretation and Source row; primary pure bladder CIS keeps its distinct extension wording.
    • Ten source-backed cases passed through visible local browser controls across 11 submissions, covering both WHO pathways, size and age boundaries, recurrent minimum, pure CIS, prostatic CIS, LVI, unresolved subtype, and reset/repeat behavior.
    • No coefficient, composition rule, risk classification, or source extension changed. Original production findings remain open until deployment and public revalidation.

    Case-level local remediation evidence is retained in validation/browser-production/bladder-cancer-eau-nmibc-risk-2021.local-remediation.json.

  3. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-ui-console. high: Valid prostatic-urethral CIS and lymphovascular-invasion overrides are correctly classified Very high risk but their interpretation says No core coefficient score applies to pure bladder CIS and their Source row says Literature extension: primary pure bladder CIS. The controlling-factor row is correct, so the rendered explanation contradicts itself. | medium: Production emitted minified React error #418 during route load.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/bladder-cancer-eau-nmibc-risk-2021.json.

  4. : Input workflow simplified and revalidated

    • Reduced the public form to result-, branch-, unit-, and applicability-changing inputs; removed or consolidated non-scoring, administrative, and duplicate questions.
    • Preserved the verified calculation or report-interpretation logic, thresholds, model version, component logic, and supported result pathways behind strict deterministic adapters.
    • Passed the calculator-specific regression audit, adapter-parity and malformed-input checks, the 144-calculator input-quality audit, and the 43-calculator entry-burden audit.

  5. : Calculation corrected

    • Replaced the simplified 2024-labeled tree with exact 2021 WHO 2004/2016 and WHO 1973 coefficients, score intervals, CIS footnote, and clinical-composition parity.
    • Restored raw age and tumor-diameter equalities, G2, recurrent minimum, and deterministic controlling-factor trace.

  6. : Scope and interpretation corrected

    • Added strict post-TURBT pretreatment scope and separately labeled extensions for pure/prostatic CIS, LVI, source-listed subtypes, and recurrent tumors.
    • Removed defaults, coercion, grade conversion, treatment directives, recurrence ambiguity, and unsupported individualized probability output.

  7. : Full validation completed

    • Passed 2,048/2,048 deterministic implementation assertions: 32 identity/source/scope, 1,280 exhaustive core, 160 overrides/applicability, 96 boundaries, 256 malformed, 96 UI/reset, 80 trace/language/immutability, and 48 registry/report/history checks.
    • This is software implementation verification, not prospective clinical validation.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

When should EAU 2021 NMIBC Prognostic Factor Risk Groups be used?

Use it for patients with non-muscle-invasive or urothelial cancer in the recurrence/progression setting described by the model when all required inputs and the intended clinical setting are confirmed.

Can EAU 2021 NMIBC Prognostic Factor Risk Groups determine treatment by itself?

No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.

Evidence-based oncology decision support. Verify with clinical guidelines.