Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model

J Urol. 2009 Nov;182(5):2195-203. doi: 10.1016/j.juro.2009.07.016. Epub 2009 Sep 16.


Purpose: Bacillus Calmette-Guerin is the most effective therapy for nonmuscle invasive bladder cancer. Recently to calculate the risks of recurrence and progression based on data from 7 European Organisation for Research and Treatment of Cancer trials a scoring system was reported. However, in that series only 171 patients were treated with bacillus Calmette-Guerin. We developed a risk stratification model to provide accurate estimates of recurrence and progression probability after bacillus Calmette-Guerin.

Materials and methods: Data were analyzed on 1,062 patients treated with bacillus Calmette-Guerin and included in 4 Spanish Urological Club for Oncological Treatment trials. Stepwise multivariate Cox models were used to determine the effect of prognostic factors. In each patient the weight of all factors was summed to a total score. Patients were then divided into groups, and cumulative recurrence and progression rates were calculated.

Results: A scoring system was calculated with a score of 0 to 16 for recurrence and 0 to 14 for progression. Patients were categorized into 4 groups by score, and recurrence and progression probabilities were calculated in each group. For recurrence the variables were gender, age, grade, tumor status, multiplicity and associated Tis. For progression the variables were age, grade, tumor status, T category, multiplicity and associated Tis. For recurrence calculated risks using Spanish Urological Club for Oncological Treatment tables were lower than those obtained with Sylvester tables. For progression probabilities were lower in our model only in patients with high risk tumors.

Conclusions: We propose a scoring model to stratify the risk of recurrence and progression in patients treated with bacillus Calmette-Guerin.

MeSH terms

  • Adjuvants, Immunologic / therapeutic use*
  • Aged
  • Aged, 80 and over
  • BCG Vaccine / therapeutic use*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / epidemiology*
  • Prognosis
  • Urinary Bladder Neoplasms / drug therapy*
  • Urinary Bladder Neoplasms / epidemiology*
  • Urinary Bladder Neoplasms / pathology


  • Adjuvants, Immunologic
  • BCG Vaccine