Original Study EORTC Progression Score Identifies Patients at High Risk of Cancer-Specific Mortality After Radical Cystectomy for Secondary Muscle-Invasive Bladder Cancer Matthias May, 1,2,3 Maximilian Burger, 4 Sabine Brookman-May, 5 Christian G. Stief, 5 Hans-Martin Fritsche, 4 Jan Roigas, 2 Mario Zacharias, 3 Markus Bader, 5 Philipp Mandel, 5 Christian Gilfrich, 1 Michael Seitz, 5, Derya Tilki 5, Abstract Of 521 patients with clinical muscle-invasive bladder cancer (MIBC), 77% had primary MIBC and 23% had secondary MIBC. Patients with secondary MIBC were stratified into risk groups according to the results of first and last transurethral resection of bladder tumor (TURBT) in non-MIBC using the European Organisation for Research and Treatment of Cancer (EORTC) progression score. Patients with secondary MIBC and the highest risk of tumor stage progression at time of first and last TURBT in non-MIBC showed a significantly higher cancer-specific mortality (CSM) after radical cystectomy (RC) compared with patients with low to intermediate risk and patients with primary MIBC. Background: The aim of this study was to develop a risk stratification of patients with muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC). For this purpose, we compared the cancer-specific mortality (CSM) of patients with primary MIBC and patients with secondary MIBC in different risk groups according to the European Organisation for Research and Treatment of Cancer (EORTC) progression score. Patients and Methods: The records of 521 consecutive patients treated with RC for clinical MIBC according to transurethral resection of bladder cancer (TURBT) diagnosis were reviewed. Of the 521 patients, 399 (76.6%) had primary MIBC (study group 1 [SG1]) and 122 (23.4%) had secondary MIBC (study group 2 [SG2]). Patients in SG2 were stratified into risk groups according to the results of the first and last TURBT in non-MIBC using the EORTC progression score. Results: CSM for patients with primary and secondary MIBC did not differ significantly. Patients in SG2 with the highest risk for tumor stage progression at time of the first and last TURBT in non-MIBC showed a significantly higher CSM after RC compared with patients with low-to- intermediate risk and compared with patients in SG1. In multivariable analyses, stage pT 3/4 (hazard ratio [HR], 2.12; P < .001), lymphovascular invasion (LVI) (HR, 3.47; P < .001), female sex (HR, 1.35; P ¼ .048), and time from diagnosis of MIBC to RC > 90 days (HR, 2.07; P < .001) were significantly associated with higher CSM. Conclusion: Risk stratification by the EORTC progression score can help to identify those patients with the highest risk of CSM after progression to MIBC and thus enable us to offer these patients a multimodal treatment. Our results need to be verified in large prospective studies. Clinical Genitourinary Cancer, Vol. -, No. -, --- ª 2013 Elsevier Inc. All rights reserved. Keywords: EORTC risk tables, Muscle invasion, Prognosis, Risk stratification, Urothelial carcinoma of the bladder  These authors share senior authorship. 1 Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany 2 Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany 3 Department of Urology, Vivantes Kliniken AVK Berlin, Berlin, Germany 4 Department of Urology, University of Regensburg, Caritas-St. Josef Medical Center, Regensburg, Germany 5 Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany Submitted: Aug 23, 2013; Revised: Oct 7, 2013; Accepted: Nov 8, 2013 Address for correspondence: Matthias May, MD, Department of Urology, St. Elisabeth Klinikum Straubing, Germany Fax: þ49-9421-7101717; e-mail contact: matthias.may@klinikum-straubing.de 1558-7673/$ - see frontmatter ª 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clgc.2013.11.014 Clinical Genitourinary Cancer Month 2013 - 1