Purpose: Oncologic outcomes in diverse malignancies are associated with inflammation-based prognostic scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). In this study, we evaluated the predictive value of pre treatment prognostic scores in differentiating muscle invasive (MIBC) and non muscle invasive (NMIBC) bladder cancer.

Materials and Methods: This prospective cross sectional study analysed consecutive transurethral resection of bladder tumour (TURBT) cases from September 2016 to December 2017. Demographics of patients, characteristics of tumour and prognostic scores results were recorded. Prognostic score cut offs were determined using receiver operating characteristics curves. The association between variables and MIBC were evaluated by performing univariate and multivariate binomial logistic regression analysis.

Results: Total patients included were 142. Of this 96 were having NMIBC (stage T1) and 46 were having MIBC (stage T2+). Median age was 75 years. 128 patients were male(90.1%) and 14 were female(9.9%). The NLR had the greatest area under the curve (AUC) of 0.748 (cut off was 3.89), followed by LMR (cutoff<1.8; AUC, 0.644) and PLR (cut off>218; AUC, 0.596). Univariate analysis identified NLR, PLR, LMR, Tumour size and Tumour multiplicity as significant predictors of muscle-invasive bladder cancer (MIBC) Table: 15. The multivariate logistic regression model identified NLR (OR, 11.822; 95% CI, 4.492 – 31.112; p=0.001) and tumour size (OR, 6.306; 95% CI, 1.563 – 25.436; p=0.010) as independent predictors of muscle-invasive bladder cancer (MIBC).

Conclusions: NLR may be used as a simple, cost-effective and easily measured marker for MIBC. It can be performed at the time of diagnostic cystoscopy, and can be used in the planning of further treatment.

Keywords: Urinary bladder neoplasms; Blood platelets; Neutrophils; Lymphocytes.

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A. T. Rajeevan

Government Medical College, Kozhikode, Kerala, India