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

Year 2026, Volume: 16 Issue: 1, 49 - 53, 19.03.2026

Yavuz Tarık Atik , Deniz Gül Anıl Erdik , Burak Uysal Recep Burak Değirmentepe Hacı İbrahim Çimen

https://izlik.org/JA33YG98AT

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

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