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

Yıl 2026, Cilt: 16 Sayı: 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

Öz

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.

Anahtar Kelimeler

bladder cancer , lymphocyte , muscle invasion , neutrophil

Kaynakça

• 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492
• 2. Cumberbatch M, Jubber I, Black PC, Esperto F, Figueroa JD, Kamat AM, et al. Epidemiology of bladder cancer: a systematic review and contemporary update of risk factors in 2018. Eur Urol. 2018;74(6):784–795. https://doi.org/10.1016/j.eururo.2018.09.001
• 3. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of nonmetastatic muscle-invasive bladder cancer: American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology clinical practice guideline summary. J Oncol Pract. 2017;13:621–625. https://doi.org/10.1200/JOP.2017.024919
• 4. Ark JT, Keegan KA, Barocas DA, Morgan TM, Resnick MJ, You C, et al. Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU Int. 2014;113:894–899. https://doi.org/10.1111/bju.12245
• 5. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–230. https://doi.org/10.1016/j.critrevonc.2013.03.010
• 6. Getzler I, Bahouth Z, Nativ O, Rubinstein J, Halachmi S. Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer. BMC Urol. 2018;18(1):1–10. https://doi.org/10.1186/s12894-018-0404-x
• 7. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883–899. https://doi.org/10.1016/j.cell.2010.01.025
• 8. Madonia M, Paliogiannis P, Solinas T, Mangoni AA, Carru C, Zinellu A. Neutrophil to lymphocyte ratio and muscular invasion in early-stage bladder cancer: a meta-analysis. Eur J Oncol. 2018;23:65–71.
• 9. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–230. https://doi.org/10.1016/j.critrevonc.2013.03.010
• 10. Li X, Ma X, Tang L, Wang B, Chen L, Zhang F, et al. Prognostic value of neutrophil to-lymphocyte ratio in urothelial carcinoma of the upper urinary tract and bladder: a systematic review and meta analysis. Oncotarget. 2016;8:62681–62692. https://doi.org/10.18632/oncotarget.17467
• 11. Margetts J, Ogle LF, Chan SL, Chan AW, Chan KC, Jamieson D, et al. Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma? Br J Cancer. 2018;118:248–257. https://doi.org/10.1038/bjc.2017.386
• 12. Mitra AP, Cai J, Miranda G, Bhanvadia S, Quinn DI, Schuckman AK, et al. Management trends and outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder: evolution of the University of Southern California Experience over 3,347 Cases. J Urol. 2022;207:302–313. https://doi.org/10.1097/JU.0000000000002242
• 13. Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):124–135. https://doi.org/10.1093/jnci/dju124
• 14. Yi M, Li T, Niu M, Mei Q, Zhao B, Chu Q, et al. Exploiting innate immunity for cancer immunotherapy. Mol Cancer. 2023;22:187–242. https://doi.org/10.1186/s12943-023-01885-w
• 15. Hassan WA, ElBanna AK, Noufal N, El-Assmy M, Lotfy H, Ali RI. Significance of tumor-associated neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio in non-invasive and invasive bladder urothelial carcinoma. J Pathol Transl Med. 2023;57(2):88–94. https://doi.org/10.4132/jptm.2022.11.06