Neutrophil to lymphocyte ratio as a recurrence predictive marker in non-muscle invasive Bladder Cancer: A retrospective cohort study

Abstract

Background: Recurrence is a main risk of non-muscle invasive bladder cancer (NMIBC). It depends on cystsoscopic and anatomopathologic factors. The outlook of current researches is to identify non-invasive prognostic factors and enhance the predictive value of existing prognostic patterns. Neutrophil to lymphocyte ratio (NLR) is a biological marker, which has demonstrated its prognostic role in several solid tumors. This study aimed to explore the interest of NLR in predicting the recurrence risk of NMIBC. Materials and Methods: This is a retrospective study of 166 patients treated for NMIBC. Demographic characteristics, clinical data, biological parameters, cystoscopic findings, pathological data and follow-up results were collected. NLR was calculated preoperatively. We adopted the cut-off value 2.5 for the NLR. Multivariate analysis and ROC curve were used to assess different correlations. The study of survival was carried out by Kaplan-Meier estimator. SPSS version 26 was used for analyzing the data. P value ≤ 0.05 was considered statistically significant. Results: The male to female ratio was 14.09. The mean age was 65.99 (standard deviation (SD) = 12.431). The mean of NLR was 2.17 (SD= 0.78). Sixty-three 63 patients (38%) had high NLR. Urothelial bladder disease follow-up revealed tumor recurrence in 87 patients (52.41%). In multivariate analysis, NLR was significantly associated with NMIBC recurrence (p=0.025). According to ROC curve, area under the curve was 72.7 % attesting the performance of this marker in BC predicting recurrence. Kaplan-Meier curves showed that a higher preoperative NLR is significantly associated with high decreased recurrence-free survival (p=0.002). Conclusions: NLR is a hematological inflammation parameter that has shown interesting prognostic properties in NMIBC. It could be used as a valuable marker allowing urologist identifying patients most likely to have recurrence of their BC. Nevertheless, prospective randomized studies are necessary for the validation of our results.