Prognostic significance of markers of systemic inflammatory response in patients with non–muscle-invasive bladder cancer

Aurélie Mbeutcha, Shahrokh F. Shariat, Malte Rieken, Michael Rink, Evanguelos Xylinas, Christian Seitz, Ilaria Lucca, Romain Mathieu, Morgan Rouprêt, Alberto Briganti, Pierre I. Karakiewicz, Tobias Klatte

Research output: Contribution to journalArticlepeer-review


Background The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non–muscle-invasive bladder cancer (NMIBC) have not been well studied yet. Patients and methods We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months. Results In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5 mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%). Conclusion In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.

Original languageEnglish
Pages (from-to)483.e17-483.e24
JournalUrologic Oncology: Seminars and Original Investigations
Issue number11
Publication statusPublished - Nov 1 2016


  • BCG
  • Biomarker
  • Guideline
  • Prediction
  • Prognosis
  • Progression
  • Response

ASJC Scopus subject areas

  • Oncology
  • Urology


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