PURPOSE: Non-muscle-invasive bladder cancers (NMIBC) constitute 3-quarters of all primary diagnosed bladder tumors. For risk-adapted management of patients with NMIBC, different risk group systems and predictive models have been developed. This study aimed to externally validate EORTC2016, CUETO and novel EAU2021 risk scoring models in a multi-institutional retrospective cohort of patients with high-grade NMIBC who were treated with an adequate BCG immunotherapy. METHODS: The Kaplan-Meier estimates for recurrence-free survival and progression-free survival were performed, predictive abilities were assessed using the concordance index (C-index) and area under the curve (AUC). RESULTS: A total of 1690 patients were included and the median follow-up was 51 months. For the overall cohort, the estimates recurrence-free survival and progression-free survival rates at 5-years were 57.1% and 82.3%, respectively. The CUETO scoring model had poor discrimination for disease recurrence (C-index/AUC for G2 and G3 grade tumors: 0.570/0.493 and 0.559/0.492) and both CUETO (C-index/AUC for G2 and G3 grade tumors: 0.634/0.521 and 0.622/0.525) EAU2021 (c-index/AUC: 0.644/0.522) had poor discrimination for disease progression. CONCLUSION: Both the CUETO and EAU2021 scoring systems were able to successfully stratify risks in our population, but presented poor discriminative value in predicting clinical events. Due to the lack of data, model validation was not possible for EORTC2016. The CUETO and EAU2021 systems overestimated the risk, especially in highest-risk patients. The risk of progression according to EORTC2016 was slightly lower when compared with our population analysis.

2nd Department of Urology Centre of Postgraduate Medical Education Warsaw Poland

Departament of Urology Hospital Universitario Ramón y Cajal IRYCIS Universidad de Alcala Madrid Spain

Department of Clinical and Experimental Pathology Wrocław Medical University Wrocław Poland

Department of Minimally Invasive Robotic Urology Center of Excellence in Urology Wrocław Medical University Wrocław Poland

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology and Neurourology Marien Hospital Herne Ruhr University Bochum Herne Germany

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of urology CHU Tours Tours France

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology Medical University of Silesia Zabrze Poland

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology Weill Cornell Medical College New York NY; Department of Urology University of Texas Southwestern Dallas TX; Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology Fundaciò Puigvert Autonoma University of Barcelona Barcelona Spain

Department of Urology Hospital Clínico San Carlos Madrid Spain

Department of Urology Hospital Universitario La Paz Madrid Spain

Department of Urology Institut Mutualiste Montsouris and Université Paris Descartes Paris France

Department of Urology IRCCS Humanitas Research Hospital Humanitas University Rozzano Italy

Department of Urology La Croix du Sud Hospital Quint Fonsegrives France

Department of Urology Policlinico Umberto 1 Sapienza University of Rome Rome Italy

Department of Urology Spedali Civili Brescia Italy

Department of Urology Stanford University Medical Center Stanford CA

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University Hospital Infanta Sofia Madrid Spain

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology University of Verona Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

Department of Urology Valencian Oncology Institute and Foundation Valencia Spain

Department of Urooncology Maria Skłodowska Curie National Research Institute of Oncology in Warsaw Warsaw Poland

Division of Experimental Oncology Department of Urology Urological Research Institute Vita Salute San Raffaele University Milan Italy

Division of Urology Department of Surgical Sciences Molinette Hospital University of Torino School of Medicine Torino Italy

Division of Urology Marche Polytechnic University Ancona Italy

Holy Cross Cancer Center in Kielce Kielce Poland

Institute of Public Health Opole University Opole Poland 68 Katowicka Street 45 060 Opole Poland

S H Ho Urology Centre Department of Surgery The Chinese University of Hong Kong Shatin Hong Kong SAR China

Section of Pathological Anatomy Marche Polytechnic University United Hospitals Ancona Italy

Urology Unit ASST Spedali Civili di Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Italy

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