Predictive value of neutrophil-to-lymphocyte ratio prior to transurethral resection for muscle invasion in bladder cancer

Abstract

Aim: To evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) before transurethral resection in determining muscle invasion in patients diagnosed with bladder cancer. Materials and Methods: This retrospective study included patients who underwent first-time transurethral resection of bladder tumors (TUR-B) for primary bladder cancer between January 2016 and December 2024. Patients with carcinoma in situ, preoperative infection, hematologic malignancies, or unexplained leukocytosis were excluded. Patients were divided into two groups based on pathological staging: Group 1 (pTa/pT1) and Group 2 (pT2). Demographic, clinical, and laboratory parameters, including leukocyte, neutrophil, and lymphocyte counts, were recorded. The optimal NLR cutoff for predicting muscle invasion was determined using ROC analysis. Statistical analyses were performed using IBM Statistical Package for Social Sciences (SPSS) program software with a significance threshold of p <0.05. Results: A total of 731 patients were included. Muscle invasion (pT2) was identified in 129 patients (17.6%). Group 2 had significantly higher age, proportion of female patients, high-grade tumors, and tumors larger than 3 cm. Lymphocyte counts were significantly lower in Group 2, while leukocyte, neutrophil counts, and NLR were significantly higher (p<0.001 for all). The optimal cutoff value of NLR was 2.96 (sensitivity: 42.6%, specificity: 89.5%, AUC: 0.701). Logistic regression revealed that female sex, high tumor grade, tumor size, and elevated NLR were independently associated with muscle invasion. Conclusion: Preoperative neutrophil-to-lymphocyte ratio (NLR) is significantly associated with muscle-invasive bladder cancer. As a simple and accessible inflammatory marker, NLR may support preoperative staging and inform clinical decision-making in bladder cancer management.

Keywords

• bladder cancer
• lymphocyte
• muscle invasion
• neutrophil

References

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