Review Article

Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer

Table 2

Clinical studies on the prognostic value of SIR-related hematological biomarkers in UC of the bladder.

StudyMarkerPublication yearNumber of patients (NMIBC/MIBC)ThresholdAssessment periodMain findings

Hilmy et al. [35]CRP2005105 (76/29)1.0 mg/dLBefore surgery (TURBT)Elevated preoperative CRP (>1) was independently associated with worse CSS

Yoshida et al. [36]CRP200888 (0/88)0.5 mg/dLBefore radiochemotherapyElevated preoperative CRP (≥0.5) was independent predictor of worse CSS

Gakis et al. [37]CRP2011246 (0/246)0.5 mg/dL or continuous1–3 days before RCPatients with elevated CRP (>0.5) showed advanced age, more extravesical disease, larger tumor size, node positive disease, and positive surgical margin and increased CRP (continuous) was independent predictor of worse CSS

Hwang et al. [39]GPS, Albumin201267 (0/67)1.0 mg/dL (CRP)
3.5 g/dL (Albumin)
1 day before first chemotherapy cycleHypoalbuminemia (<3.5) and GPS 2 was independently associated with reduced PFS and OS, respectively

Ku et al. [46]Albumin
Neutrophil count
Platelet count
2015419 (173/246)3.5 g/dL (Albumin)
7500/uL (Neutrophil)
400 × 105/ul (Platelet)
Before RCLow albumin, high lymphocyte count, and high platelet count were significantly
associated with worse OS and CSS

Gondo et al. [38]NLR2012189 (62/127)2.5Before RCElevated NLR (≥2.5) was an independent predictor of worse DSS

Demirtaş et al. [40]NLR2013201 (35/166)2.5Before RCElevated NLR (>2.5) was not associated with overall survival

Hermanns et al. [41]NLR20144243Before RCPatients with elevated NLR (≥3) significantly showed more advanced pathologic tumor stage
Elevated NLR (≥3) was significantly associated with RFS, OS, and CSS

Kaynar et al. [42] NLR2014291 (192/99)NA (continuous)1 day before surgery (TURBT or RC)Patients with MIBC showed significantly higher NLR value than those with NMIBC
Also, higher NLR significantly correlated with advanced age, larger tumor size, and aggressive tumor invasiveness

Potretzke et al. [43]NLR2014102 (31/71)NA (continuous)Before RCNLR was significant predictor of pathological upstaging after RC; also, patients with pathological upstaging to ≥pT3 had a significantly greater NLR compared to patents who remained at ≤pT2

Viers et al. [44]NLR2014899 (392/507)2.7Within 90 days before RCElevated NLR (≥2.7) was significantly associated with adverse pathologic finding (higher pathologic tumor stage, node positive, and larger tumor size); increased NLR (continuous) was independently associated with worse RFS, OS, and CSS

Mano et al. [47]NLR2015107 (107/0)2.41 (for progression)
2.43 (for recurrence)
Before TURBTElevated NLR (>2.41) showed more pT1 tumors and was significantly associated with disease progression;
elevated NLR (>2.43) was independent predictor of disease recurrence

Seah et al. [48]NLR201526 (0/26)NABefore NACH, during NACH, and after RCSignificant NLR decrease from before NACH to before RC was observed in patients with pathological response after NACH and RC

Kang et al. [45]NLR2015385 2.0 (postoperative)
2.1 (preoperative)
Within 1 month before RC and within 3 months after RCPatients with elevated postoperative NLR (≥2.0) had higher rates of ≥pT3, LVI, and positive lymph node and elevated postoperative NLR (≥2.0) was an independent predictor of OS and CSS; also, patients with perioperative continuous elevated NLR (2.1–>2.0) showed worse OS and CSS compared with other change groups

CRP: C-reactive protein, GPS: Glasgow Prognostic Score, mGPS: modified Glasgow Prognostic Score, NLR: neutrophil-to-lymphocyte ratio, TURBT: transurethral resection of bladder tumor, RC: radical cystectomy, NACH: neoadjuvant chemotherapy, NMIBC: nonmuscle invasive bladder cancer, OS: overall survival, DSS: disease-specific survival, RFS: recurrence-free survival, and CSS: cancer specific survival.