Pretreatment PLR Is Preferable to NLR and LMR as a Predictor in Locally Advanced and Metastatic Bladder Cancer

Canan Karan; Arzu Yaren; Burcin Cakan Demirel; Tolga Dogan; Melek Ozdemir; Atike Gokcen Demiray; Burcu Yapar Taskoylu; Serkan Degirmencioglu; Gamze Dogu; Nail Ozhan; Umut Cakiroglu; Atalay Celikyurek

doi:10.21873/cdp.10275

Pretreatment PLR Is Preferable to NLR and LMR as a Predictor in Locally Advanced and Metastatic Bladder Cancer

Cancer Diagn Progn. 2023 Nov 3;3(6):706-715. doi: 10.21873/cdp.10275. eCollection 2023 Nov-Dec.

Affiliations

¹ Department of Medical Oncology, Dr. Ersin Aslan Training and Research Hospital, Gaziantep, Turkey.
² Department of Medical Oncology, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
³ Department of Medical Oncology, Egekent Hospital, Denizli, Turkey.
⁴ Department of Medical Oncology, Buca Seyfi Demirsoy Training and Research Hospital, Ιzmir, Turkey.
⁵ Department of Public Health, Pamukkale University, Faculty of Medicine, Denizli, Turkey.

Abstract

Background/aim: Advanced bladder cancer (BC) is associated with an inflammatory nature and poor prognosis Inflammatory biomarkers are potential predictors in BC. We conducted a study to assess the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in advanced bladder cancer.

Patients and methods: A total of 226-patients with muscle-invasive BC (MIBC) were included. Overall (OS) and progression-free survival were estimated using the Kaplan-Meier method and the log-rank test was used for comparison. Univariate and multivariate Cox proportional hazard models were used to determine NLR, PLR, and LMR association with OS.

Results: Our patients' median progression-free survival and OS were 12.18 and 15.54 months, respectively. Receiver operating characteristic analysis revealed cut-off values for our chosen inflammatory markers. The patients with high NLR or PLR had inferior median OS compared to their counterparts with lower ratios for both (NLR: 22.51 vs. 9.84 months, respectively, p≤0.001; PLR: 17.68 vs. 14.08 months, respectively, p=0.08). Meanwhile, patients with low LMR had inferior median OS compared to patients with higher LMR (LMR: 20.14 months vs. 10.55 months, respectively, p<0.001). The multivariate Cox regression analysis identified a high PLR as an independent predictive factor of worse OS (hazard ratio=2.774, 95% confidence interval=1.486-5.178, p=0.001) but not NLR or LMR.

Conclusion: PLR, C-reactive protein-to-albumin ratio, and serum LDH levels, but not NLR and LMR, may function as independent predictors in patients with advanced BC prior to systemic treatment.

Keywords: Bladder cancer; LMR; NLR; PLR; inflammation markers; overall survival; prognostic factors.