Preoperative neutrophil–lymphocyte ratio and fibrinogen level in patients distinguish between muscle-invasive bladder cancer and non-muscle-invasive bladder cancer

Abstract

IntroductionThe aim of this study was to explore if the preoperative neutrophil–lymphocyte ratio (NLR) and fibrinogen level can help in distinguishing between muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC).MethodsWe identified 669 patients who underwent surgery at our institution, and evaluated their preoperative NLRs and fibrinogen levels. Patients were divided into two groups, NMIBC (group-I) and MIBC (group-II), according to the postoperative pathology. For the intergroup comparison, data obtained from the two groups were evaluated using independent samples t-test. The cutoff value of the NLR, fibrinogen level, and integrated NLR and fibrinogen level was determined with receiver operating characteristic (ROC) curve.ResultsThe mean NLRs of group-I and group-II were found as 2.71±2.46 and 4.66±8.00, respectively (P<0.001). The fibrinogen levels of the two groups were ~3.13±0.70 g/L and 3.41±0.84 g/L, respectively (P=0.001). Whether the NLR, fibrinogen level, and integrated NLR and fibrinogen level can help in distinguishing between MIBC and NMIBC was evaluated with ROC curve. The cutoff value of NLR was estimated as 2.01 according to the Youden index. With this value, sensitivity was found as 67.1%, specificity was 52.7%, and area under receiver operating characteristic (ROC) curve (AUC) was 0.601 (P=0.031). The cutoff value of fibrinogen level was estimated as 3.17 g/L according to the Youden index. Accordingly, sensitivity was found as 58%, specificity was 58%, and AUC was 0.60 (P=0.001). The cutoff value of integrated NLR and fibrinogen level was found as 0.166; the sensitivity was found as 86%, specificity was 42%, and AUC was 0.801 (P=0.01).ConclusionThe data obtained in this study suggested that 67.1% of Ta-T1 tumors were likely to be invasive if the NLR was >2.01 and 58% were likely to be invasive if the fibrinogen level was >3.17 g/L. When we used both the NLR and fibrinogen level to distinguish between the MIBC and NMIBC, sensitivity was found to be 86%, and specificity was 42%.

Development of a Tool for Prediction of Ovarian Cancer in Patients With Adnexal Masses: Value of Plasma Fibrinogen

“…Assumption was made that the identification of ovarian cancer would lead to surgery. Apart from being one of the key proteins within the formation of blood clots and inflammatory processes, plasma fibrinogen levels have been found to be elevated in patients with a poor prognosis in various malignant tumours including OC [20][21][22][23][24][25][26][27]. Moreover, our study group has previously investigated the predictive role of plasma fibrinogen to distinguish between benign and malignant ovarian tumours [25].…”

“…Fibrinogen is a key protein in the coagulation pathway and one of the major acute phase proteins, strongly linked to inflammation and stress. It has been found have prognostic value for various malignant tumours including ovarian cancer [20][21][22][23][24][25][26][27]. We have previously reported that pre-operative plasma fibrinogen is independently associated with ovarian cancer presence in patients with adnexal masses [25].…”

Cerebrospinal fluid metabolomic profiles can discriminate patients with leptomeningeal carcinomatosis from patients at high risk for leptomeningeal metastasis

“…Fibrinogen fragment is also associated with inflammation and cancers. Up-regulation of fibrinogen production in blood can be a useful prognostic factor in various types of cancers (e.g., ovarian [ 24 ], bladder [ 25 ], lung [ 26 ], renal [ 27 ], and colorectal [ 11 ]). Increased CSF fibrinogen levels have not been reported for solid cancer metastases, but deranged levels have been found in CSF from children with leukemia [ 28 ].…”

Development of a tool for prediction of ovarian cancer in patients with adnexal masses: Value of plasma fibrinogen

“…Apart from being one of the key proteins within the formation of blood clots and inflammatory processes, plasma fibrinogen levels have been found to be elevated in patients with a poor prognosis in various malignant tumours including OC [ 20 – 27 ]. Moreover, our study group has previously investigated the predictive role of plasma fibrinogen to distinguish between benign and malignant ovarian tumours [ 25 ].…”

“…Fibrinogen is a key protein in the coagulation pathway and one of the major acute phase proteins, strongly linked to inflammation and stress. It has been found have prognostic value for various malignant tumours including ovarian cancer [ 20 – 27 ]. We have previously reported that pre-operative plasma fibrinogen is independently associated with ovarian cancer presence in patients with adnexal masses [ 25 ].…”