Neutrophil to lymphocyte ratio as a recurrence predictive marker in non-muscle invasive Bladder Cancer: A retrospective cohort study

Background: Recurrence is a main risk of non-muscle invasive bladder cancer (NMIBC). It depends on cystsoscopic and anatomopathologic factors. The outlook of current researches is to identify non-invasive prognostic factors and enhance the predictive value of existing prognostic patterns. Neutrophil to lymphocyte ratio (NLR) is a biological marker, which has demonstrated its prognostic role in several solid tumors. This study aimed to explore the interest of NLR in predicting the recurrence risk of NMIBC. Materials: and Methods: This is a retrospective study of 166 patients treated for NMIBC. Demographic characteristics, clinical data, biological parameters, cystoscopic findings, pathological data and follow-up results were collected. NLR was calculated preoperatively. We adopted the cut-off value 2.5 for the NLR. Multivariate analysis and ROC curve were used to assess different correlations. The study of survival was carried out by Kaplan-Meier estimator. SPSS version 26 was used for analyzing the data. P value ≤ 0.05 was considered statistically significant. Results: : The male to female ratio was 14.09. The mean age was 65.99 (standard deviation (SD) = 12.431). The mean of NLR was 2.17 (SD= 0.78). Sixty-three 63 patients (38%) had high NLR. Urothelial bladder disease follow-up revealed tumor recurrence in 87 patients (52.41%). In multivariate analysis, NLR was significantly associated with NMIBC recurrence (p=0.025). According to ROC curve, area under the curve was 72.7 % attesting the performance of this marker in BC predicting recurrence. Kaplan-Meier curves showed that a higher preoperative NLR is significantly associated with high decreased recurrence-free survival (p=0.002). Conclusions: : NLR is a hematological inflammation parameter that has shown interesting prognostic properties in NMIBC. It could be used as a valuable marker allowing urologist identifying patients most likely to have recurrence of their BC. Nevertheless, prospective randomized studies are necessary for the validation of our results.