The impact of postoperative inflammatory biomarkers on oncologic outcomes of bladder cancer

Introduction. The clinical impact of inflammatory biomarkers has been evaluated in urothelial bladder cancer. However, data are limited to preoperative values and there is paucity of evidence of the role of postoperative measurement of those biomarkers. The aim of the current study was to determine the association of inflammatory biomarkers as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), hemoglobin to platelet ratio (HPR) and C-reactive protein (CRP), before and after radical cystectomy, with recurrence and survival of bladder cancer. Material and methods. We prospectively evaluated 134 patients undergoing radical cystectomy for invasive bladder cancer between January 2013 and January 2018. The inflammatory biomarkers were measured 10 days before surgery and at 1, 6 and 12 months postoperatively. Kaplan Meier curves and Cox proportional hazards and logistic regression models were used to evaluate the association between the different inflammatory biomarkers and recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Results. The median follow-up time was 21.1 months (5-37 mo). On multivariate analysis, preoperative NLR > 3.88 was associated to locally-advanced disease (> pT3) and NLR > 3.88 and HPR < 0.039 were significantly associated to node positive disease. Postoperative NLR at 3 months > 4.68 (HR: 2.37, 95% CI: 1.08-4.47, P=0.03) was associated with a reduced RFS. A postoperative NLR at 3 months > 4.68 (P= 0.04) and a postoperative HPR at 3 months < 0.029 (P= 0.001) were associated with a significant reduction in CSS and OS. Conclusion. Postoperative NLR and HPR at 3 months appear to be closely associated with RFS, CSS and OS. Further studies are needed on these postoperative markers to establish the potential impact of these inflammatory biomarkers on a tailored therapeutic approach for each patient. Level of evidence. 3. (C) 2019 Elsevier Masson SAS. All rights reserved.