Non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease, with Ta tumors accounting for about 70% of cases. Prognosis varies widely, especially among high-grade (HG) tumors, and current predictive systems remain imperfect. This study aimed to provide an external validation of the EAU 2021 classification for Ta HG tumors.
A retrospective European multicenter study was conducted in 316 TaHG NMIBC. According to the presence or absence of risk factors (age > 70 years, multifocality, tumor size > 3 cm), we categorized TaHG between intermediate-risk (IR) and high-risk (HR) NMIBC. Oncological outcomes included overall and HG recurrence-free survival (RFS), progression free-survival (PFS), cystectomy free-survival (CFS), cancer specific survival (CSS) and overall survival (OS). Uni- and multivariable Cox regression analyses were used to identify the independent predictors of disease recurrence and progression.
Overall, 197 (62%) and 119 (38%) patients had IR and HR HG Ta NMIBC, respectively. All patients received endovesical instillations (BCG or chemotherapy). After a median follow-up of 36.0 [32.0; 42.0] months, IR was significantly associated with a higher 3-yr overall RFS (78.6% vs. 66.5%; p = 0.01), 3-yr HG RFS (79.9% vs. 69.2%; p = 0.03) and 3-yr PFS (97.2% vs. 91.5%; p = 0.02). CFS, CSS and OS were similar between IR and HR (all p > 0.05). Multivariable Cox regression analysis confirmed that HR vs. IR group was significantly associated with overall disease recurrence (HR = 1.69; p = 0.03), HG disease recurrence; (HR = 1.58; p = 0.04) and disease progression (HR = 2.33; p = 0.05).
The European classification of TaHG NMIBC offers useful prognostic insight, especially concerning disease recurrence and progression.
World journal of urology. 2026 May 13*** epublish ***
Manon Cournède, Pierre-Etienne Gabriel, Marine Lottin, Marco Moschini, Francesco Soria, David D'Andrea, Shahrokh F Shariat, Alexandra Budowski, Cédric Poyet, Mathieu Roumiguie, Mario Alvarez-Maestro, Alberto Briganti, Wojciech Krajewski, Kees Hendricksen, Hans Veerman, Luca Afferi, Agostino Mattei, Carlo Di Bona, Stefania Zamboni, Claudio Simeone, Ronan Thenault, Gregory Verhoest, Paolo Gontero, Evanguelos Xylinas
Department of Urology, Amiens University Hospital, 80054, Amiens, France., Department of Urology, Bichat Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris Nord, University Paris Cité, Paris, France. ., Department of Oncology, Amiens University Hospital, 80054, Amiens, France., Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy., Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Department of Anesthesiology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland., Department of Urology, Stadtspital Triemli, 8063, Zurich, Switzerland., Urology Department, Clinique Pasteur, Toulouse, France., Department of Urology, La Paz University Hospital, Madrid, Spain., Unit of Urology, Gianfranco Soldera Prostate Cancer Laboratory, Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cancer Research UK, Therapeutic Discovery Laboratories, Jonas Webb Building, Babraham Research Campus, Cambridge, UK., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy., Service d'urologie, Department of Urology, Rennes University Hospital, Hôpital Pontchaillou, Rennes, France., Department of Urology, Bichat Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris Nord, University Paris Cité, Paris, France.