A Composite Risk Score Based on VI-RADS, Tumor Contact Length, and CYFRA 21-1 for Prognostic Stratification in Bladder Cancer

<b>Background/Objectives</b>: The Vesical Imaging-Reporting and Data System (VI-RADS) provides high diagnostic accuracy for muscle-invasive bladder cancer; however, its prognostic value remains limited. We propose serum cytokeratin 19 fragment (CYFRA 21-1) and tumor contact length (TCL) as complementary prognostic factors. We aimed to construct a composite risk score integrating VI-RADS, CYFRA 21-1, and TCL for prognostic stratification. <b>Methods</b>: We retrospectively analyzed data from 101 patients with bladder cancer (BC) who underwent transurethral resection of bladder tumor (TURBT), magnetic resonance imaging, and postoperative serum CYFRA 21-1 measurement. For each factor, cut-off values were determined using receiver operating characteristic (ROC) analysis; meeting each threshold contributed one point (score range, 0-3). Overall survival (OS) was assessed using Kaplan-Meier and Cox regression analyses. <b>Results</b>: ROC analysis identified cut-offs of VI-RADS ≥ 3 (area under the curve [AUC] 0.779), TCL ≥ 40 mm (AUC 0.817), and CYFRA 21-1 ≥ 2.1 ng/mL (AUC 0.875). Based on these, patients were stratified into low- (0-1, <i>n</i> = 81), intermediate- (2, <i>n</i> = 12), and high-risk (3, <i>n</i> = 8) groups with 3-year OS rates of 95.1%, 75.0%, and 25.0%, respectively (<i>p</i> < 0.001). In univariate Cox regression, all factors significantly predicted poor OS: VI-RADS ≥ 3 (hazard ratio [HR], 6.51; <i>p</i> = 0.015), TCL ≥ 40 mm (HR, 8.36; <i>p</i> < 0.001), and CYFRA 21-1 ≥ 2.1 ng/mL (HR, 14.02; <i>p</i> < 0.001). In multivariate analysis, only CYFRA 21-1 remained independently significant (HR, 11.80; <i>p</i> < 0.001). <b>Conclusions</b>: A composite risk score combining VI-RADS, TCL, and CYFRA 21-1 effectively stratified patients with BC into distinct groups using minimally invasive, peri-TURBT assessments. Prospective multicenter validation is warranted.