Correlation of Tumor-Infiltrating Neutrophils and Tumor-Infiltrating Lymphocytes with Early Recurrence in Patients with Non-Muscle Invasive Bladder Urothelial Carcinoma (Short-Term Prospective Cohort Study)

Background: Tumor-infiltrating neutrophils (TINs) and lymphocytes (TILs) play essential roles in promoting or combating various neoplasms, the prognostic value of TILs, TINs and neutrophil to lymphocyte ratio (NLR) in bladder cancer (BC) is still unconcluded. Aim To investigate the association between TINs and CD8 + T-lymphocytes, as well as NLR with progressive non-muscle invasive urothelial bladder carcinoma (NMIBC). Methods Patients with newly diagnosed NMIBC underwent transurethral resection of bladder tumor (TURBT) followed by a standard BCG regimen, follow-up cystoscopy was performed every 3-months for the first 2-years. Tumor characteristics and histopathological examination were documented. As regards immunohistochemical evaluation, the tumors categorized into two main groups: high or low, according to their TINs, and CD8 + T-lymphocytes immunohistochemically expression and NLR. Kaplan-Meier estimates were used to compare the recurrence-free survival. Results 104 patients with NMIBC were included; Ta and T1 represented 23.1% and 76.9% of patients respectively. High-grade (HG) and low-grade (LG) were 53.8% and 46.2%, respectively. Tumor recurrence and progression were correlated to a higher stage and grade (p = 0.05). Regardless stage and grade; recurrence was more likely to occur in high TINs and TILs groups, while progression was more likely in high TILs and NLR (p < 0.05). In Ta LG tumours, the higher TINs and NLR were associated with higher recurrence rate. In T1 (LG) tumour; low TINs, high TILs, and low NLR were associated lower recurrence and progression rate, In T1 HG tumours; high TINs and NLR were associated clinical and statistically lower recurrence rate. Kaplan-Meier survival analysis showed that TINs and TILs were significantly related to the short recurrence free survival (RFS) (p = 0.03, p = 0.001). Conclusion TINs, CD8 + lymphocytes and NLR are important prognostic predictors in patients with NMIBC. Recurrence was more likely to occur in the high TINs and TILs groups, while higher TILs and NLR were correlated to tumour progression.