Prognostic Factors of Long-Term Survival in Non-Muscle-Invasive Bladder Cancer: An 18-Year Retrospective Study from Real-Life Practice

Introduction: Non-muscle-invasive bladder cancer (NMIBC) is common and heterogeneous, requiring risk-adapted therapeutic strategies. BCG remains standard for intermediate- and high-risk forms, but its effectiveness is influenced by limited access, variable tolerance, treatment resistance, and healthcare system disruptions. Material and Methods: This retrospective study aimed to identify prognostic factors for survival with an additional assessment of the influence of the COVID-19 pandemic. Although we could not directly evaluate the effect of COVID- 19 pandemic due to lack of recorded variables,we hypothesize it may have contributed to the limited impact of BCG therapy in our real-world setting. A total of 100 patients were selected from an initial group of 297 diagnosed in the Urology Clinic of Tg.Mures between 2006 - 2008, followed up until 2024. Prognostic analysis included clinical variables, RecScore and ProgScore were calculated using the EORTC risk calculator. No specific cut-offs were applied; the scores were analyzed as continuous variables. Results: Age over 70 and tumor multiplicity were significantly associated with increased mortality. RecScore was significantly correlated with the risk of relapse (p=0.0464). ProgScore showed a marginal association with mortality in univariate analysis (p=0.0561), but was not significant in multivariate models (p=0,9159). BCG therapy had a marginal protective effect, but did not significantly influence survival. Although we could not directly evaluate the effect of COVID-19 pandemic due to lack of recorded variables,we hypothesize that it may have contributed to treatment discontinuities in this real-life cohort. Conclusions: The results support the need for personalized, risk-based strategies and underline the importance of integrating real-world data into NMIBC management, especially in the context of systemic disruptions.