Predictive value of systemic inflammatory response markers before treatment of non-muscle invasive bladder cancer patients, initial intravesical Bacillus Calmette-Guerin treatment after transurethral resection of bladder tumor

The study investigated the pretreatment systemic inflammatory response (SIR) markers of patients who underwent initial intravesical treatment for high-risk non-muscle invasive bladder cancer (NMIBC). 385 patients who underwent initial intravesical Bacillus Calmette-Guerin treatment after transurethral resection of bladder tumor were included. We analyzed the relationship between standardized incidence ratio of SIR markers, such as neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR) and platelet-to-lymphocyte ratio (PLR), and oncological outcomes. Each SIR marker was used for analysis by determining the cut-off value through receiver operation characteristics curves analysis. Patients were divided into two groups according to pretreatment NLR (&lt;1.5 vs ≥1.5), dNLR (&lt;1.2 vs ≥1.2) and PLR values (171 Cox multivariate analysis revealed that age. NLR, dNLR, hemoglobin, and pathologic T stage were important factors for predicting overall survival. Age, NLR, and pathologic T stage were important factors for predicting cancer-specific survival, NLR and tumor number were the most important predictors of bladder preserving survival.<b> </b>NLR before treatment was correlated with both oncological outcomes and survival outcome in NMIBC patients undergoing initial intravesical BCG treatment after TURB. Increased NLR reflects a poor prognosis of these outcomes.

本研究针对接受初始膀胱内治疗的高危非肌层浸润性膀胱癌（non-muscle invasive bladder cancer, NMIBC）患者的预处理前全身炎症反应（systemic inflammatory response, SIR）标志物展开探究。本研究纳入385名经尿道膀胱肿瘤切除术（transurethral resection of bladder tumor, TURB）后接受初始膀胱内卡介苗（Bacillus Calmette-Guerin, BCG）治疗的患者，分析中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）、衍生中性粒细胞与淋巴细胞比值（derived neutrophil-to-lymphocyte ratio, dNLR）及血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）等全身炎症反应标志物的标准化发病率与肿瘤学结局之间的关联。研究通过受试者工作特征曲线（receiver operating characteristic curve, ROC曲线）分析确定临界值，以此对各项全身炎症反应标志物进行分析，并依据预处理前的NLR（<1.5 vs ≥1.5）、dNLR（<1.2 vs ≥1.2）及PLR数值将患者分为两组。Cox多因素分析结果显示，年龄、NLR、dNLR、血红蛋白水平及病理T分期是预测总生存期的重要影响因素；年龄、NLR及病理T分期是预测肿瘤特异性生存期的重要影响因素；而NLR与肿瘤数量则是预测膀胱保留生存期的最关键预测因子。接受经尿道膀胱肿瘤切除术（TURB）后初始膀胱内BCG治疗的非肌层浸润性膀胱癌患者中，治疗前的NLR水平与肿瘤学结局及生存结局均存在显著相关性，升高的NLR提示此类患者的上述结局预后不良。