Prognostic value of preoperative systemic inflammatory responses in patients with non-muscle invasive bladder cancer undergoing transurethral resection of bladder tumor

Several systemic inflammatory response biomarkers are associated with oncological outcomes. We aimed to evaluate the clinical significance of preoperative C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) for prediction of tumor recurrence and progression in patients with non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). A total of 207 patients with NMIBC, who underwent TURBT, were enrolled in this single-center study. Receiver operating characteristic curve (ROC) was performed to assess the optimal cut-off values for four biomarkers. The endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). The Kaplan-Meier method and the log-rank test were used for RFS and PFS estimation. To identify an optimal prognostic model for survival, Cox proportional hazards regression method was used with forward stepwise selection. The median follow-up after TURBT was 21 months. Univariate analysis revealed elevated preoperative CRP, NLR, PLR, and low LMR was significantly associated with worse RFS and PFS. On multivariable analyses, elevated PLR was an independent predictor of RFS and PFS after adjusting for potential confounding variables (Hazard ratio [HR]: 2.736; 95% Confidence interval [CI]: 1.455-5.144; P=0.002; HR: 4.089; 95% CI: 1.516-11.027, P=0.005; respectively). CRP was also independently predictive of PFS (HR: 5.222; 95% CI: 1.687-16.160, P=0.004), but not RFS. Elevated preoperative PLR was significantly associated with a higher risk of disease progression and recurrence in patients with NMIBC who underwent TURBT. Preoperative PLR may be an independent predictor of oncological outcomes in patients with NMIBC.