147 Neoplasma, 65, 1, 2018 doi:10.4149/neo_2018_170217N123 Predictors and prognostic implications of clinical decisions in patients with primary high-risk non-muscle-invasive bladder cancer – results of a cross country retrospective study S. POLETAJEW 1, *, R. BIERNACKI 2 , P. BURACZYNSKI 3 , J. CHOJNACKI 4 , S. CZARNIECKI 5 , D. GAJEWSKA 6 , T. POHABA 7 , J. SONDKA-MIGDALSKA 8 , M. SKRZYPCZYK 4 , T. SUCHOJAD 9 , D. WOJTKOWIAK 10 , B. ZAFOREMSKI 11 , L. ZAPALA 12 , A. ZEMLA 13 , P. RADZISZEWSKI 1 1 Department of Urology, Medical University of Warsaw, Warsaw, Poland; 2 Department of Urology, Te Regional Hospital, Leszno, Poland; 3 Depart- ment of Urology, Medical University of Lublin, Lublin, Poland; 4 Department of Urology, Center of Postgraduate Medical Education, Warsaw, Poland; 5 Department of Urology, John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; 6 Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland; 7 Department of Urology, Te Regional Multidisciplinary Hospital, Jastrzebie Zdroj, Poland; 8 First Department of Urology, Military Medical Academy University Teaching Hospital - Central Veterans Hospital, Lodz, Poland; 9 Departament of Urology, Provincial Specialist Hospital, Czerwona Gora, Poland; 10 Department of Urology, Regional Hospital Centrum, Jelenia Gora, Poland; 11 Department of Urol- ogy and Oncological Urology, John Paul II Subcarpatian Provincial Hospital, Krosno, Poland; 12 Department of Urology, Multidisciplinary Hospital Warsaw-Miedzylesie, Warsaw, Poland; 13 Department of Urology and Urological Oncology, Lowersilesian Multidisciplinary Hospital, Wroclaw, Poland *Correspondence: slawomir.poletajew@wum.edu.pl Received February 17, 2017 / Accepted May 9, 2017 Adjuvant diagnostic and therapeutic procedures are available to reduce the risk of recurrence or progression in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). However, their indications and efcacy remain a matter of debate. Te aim of this study was to analyze therapeutic decisions in patients with primary high-risk NMIBC and to analyze the adherence to clinical guidelines in this feld. 545 consecutive patients, aged a median of 70.3 years, diagnosed with primary high-risk NMIBC in thirteen urological institutions, were enrolled into this retrospective study. Diagnostic and therapeutic decisions afer transurethral resection (TUR) were recorded, and predictive factors were analyzed. Restaging TUR was ofered to 260 patients (47.7%), up-front intravesical Bacillus Calmette-Guerin (BCG) therapy to 74 patients (13.6%), immediate radical cystectomy to 38 patients (7.0%), and intravesical chemotherapy with the maintenance therapy to 12 patients (2.2%). No additional procedure was performed in 161 patients (29.5%). Te strongest predictive factor for restaging TUR was G3 or high-grade cancer (RR 1.68, p<0.01), for upfront BCG therapy it was carcinoma in situ (RR 3.20, p=0.01), for immediate cystectomy it was stage T1 tumor (RR 3.71, p<0.01), for no additional procedures it was G2 or low-grade cancer (RR 2.18, p<0.01). Clinical management of patients with high-risk NMIBC is suboptimal and not standardized. As this can directly infu- ence patients’ survival, urgent improvement of urological care in this feld should be considered. Key words: bladder cancer, clinical decision-making, multicenter study, survival In patients with non-muscle-invasive bladder cancer (NMIBC), transurethral resection of the bladder tumor (TUR) remains the critical step in disease management [1]. However, there is a subgroup of patients, in whom the probability of disease recurrence and progression during the follow-up is particularly high, reaching 78% and 45% at fve years, respectively [2]. Experts of the European Association of Urology defne this high-risk group as patients with stage T1 tumors, G3 tumors, high-grade tumors or carcinoma in situ (Cis) [3]. Te primary goals of TUR are complete removal of the tumor and proper pathological staging [3]. Tey both may require second or restaging TUR, especially in high-risk patients. Once proper pathological staging is completed, various therapeutic procedures are believed to reduce the risk of disease recurrence, including intravesical chemo- therapy, intravesical Bacillus Calmette-Guerin (BCG) immunotherapy, and immediate radical cystectomy. To date, in patients with high-risk NMIBC, there are controversies regarding indications for restaging TUR, indications and