Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Primary Non–muscle-invasive Bladder Cancer

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The neutrophil-to-lymphocyte ratio is associated with poor outcomes in patients with muscle-invasive bladder cancer. We found that the neutrophil-to-lymphocyte ratio is independently associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer.


The purpose of this study was to assess the role of pretreatment neutrophil-to-lymphocyte ratio (NLR) as a predictor of clinical outcomes in patients treated with transurethral resection (TURB) for primary non–muscle-invasive bladder cancer (NMIBC).

Patients and Methods:

Data from 918 patients treated with TURB for primary NMIBC were retrospectively collected. NLR was evaluated as binary variable with the cut-point of 3 based on the visual best correlation of the receiver operating curve analyses focusing on disease recurrence. The median follow-up was 62 months. Cox regression analyses were used to evaluate associations with recurrence (RFS) and progression-free survival (PFS). Subgroup analyses were done according to risk groups and receipt of intravesical bacillus Calmette-Guérin therapy.


Overall, 293 patients had a NLR ≥ 3. High NLR was associated with pathologic T stage and smoking status. The 5-year RFS and PFS for NLR < 3 and NLR ≥ 3 were, respectively, 55.5% versus 45.9% (P = .01) and 94.9% versus 89.9% (P = .004). On multivariable analyses, NLR ≥ 3 remained significantly associated with RFS and PFS. The addition of NLR increased the discrimination of a multivariable model by 0.6% and 2.3% for RFS and PFS, respectively. Moreover, NLR showed a trend in the association with outcomes in patients treated with intravesical bacillus Calmette-Guérin therapy.


Integration of NLR in a prediction model could be helpful in predicting RFS and PFS in patients with primary NMIBC and identifying those who are likely to fail therapy and may benefit from an early radical cystectomy. Limitations are associated to the retrospective design.

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