Abstract
Background: A systemic inflammatory marker, the modified Glasgow prognostic score (mGPS), could predict outcomes in non-muscle-invasive bladder cancer (NIMBC). We aimed to investigate the predictive power of mGPS in oncological outcomes in HG/G3 T1 NMIBC patients undergoing Bacillus Calmette–Guérin (BCG) therapy. Methods: We retrospectively reviewed patient’s medical data from multicenter institutions. A total of 1382 patients with HG/G3 T1 NMIBC have been administered adjuvant intravesical BCG therapy, every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months. The analysis of mGPS for recurrence and progression was performed using multivariable and univariable Cox regression models. Results: During follow-up, 659 patients (47.68%) suffered recurrence, 441 (31.91%) suffered progression, 156 (11.28%) died of all causes, and 67 (4.84%) died of bladder cancer. At multivariable analysis, neutrophil to lymphocyte ratio [hazard ratio (HR): 7.471; p = 0.0001] and erythrocyte sedimentation rate (ESR) (HR: 0.706; p = 0.006 were significantly associated with recurrence. mGPS has no statistical significance for progression (p = 0.076). Kaplan–Meier survival analysis showed a significant difference in survival among patients from different mGPS subgroups. Five-year OS was 93% (CI 95% 92–94), in patients with mGPS 0, 82.2% (CI 95% 78.9–85.5) in patients with mGPS 1 and 78.1% (CI 95% 60.4–70) in mGPS 2 patients. Five-year CSS was 98% (CI 95% 97–99) in patients with mGPS 0, 90% (CI 95% 87–94) in patients with mGPS 1, and 100% in mGPS 2 patients. Limitations are applicable to a retrospective study. Conclusions: mGPS may have the potential to predict recurrence in HG/G3 T1 NMIBC patients, but more prospective, with large cohorts, studies are needed to study the influence of systemic inflammatory markers in prediction of outcomes in NMIBC for a definitive conclusion.
Highlights
Bladder cancer is the 10th most common diagnosed cancer in the world, with estimated 573,000 new cases and 213,000 deaths in 2021
We found that neutrophil-to-lymphocyte ratio (NLR) (Neutrophil to Lymphocyte Ratio) [hazard ratio (HR): 7.471; p = 0.0001], ESR (HR: 0.762; p = 0.006) were significantly associated with recurrence. modified Glasgow prognostic score (mGPS) 1 (HR: 1.417; p = 0.0001) is significantly associated with an increased risk of recurrence (Table 3)
In this retrospective longitudinal study, we evaluated the association between mGPS and the clinical outcome of Non-muscle invasive bladder cancer (NMIBC) patients undergoing transurethral resection of bladder tumor (TURBT) plus adjuvant Bacillus Calmette–Guérin (BCG) intravesical instillation therapy
Summary
Bladder cancer is the 10th most common diagnosed cancer in the world, with estimated 573,000 new cases and 213,000 deaths in 2021. Non-muscle invasive bladder cancer (NMIBC) patients treated with 1–3 years of maintenance Bacillus Calmette–Guérin (BCG), especially high-grade (HG)/G3 T1 patients are among the highest risk for disease-progression, with 1- and 5-year rates of 11.4% and 19.8%, respectively [4,5,6]. CRP has been studied and incorporated along with albumin, into a risk score model, the modified Glasgow prognostic score (mGPS), which showed an independent prognostic value in patients undergoing radical cystectomy [19] and radiotherapy [20]. A systemic inflammatory marker, the modified Glasgow prognostic score (mGPS), could predict outcomes in non-muscle-invasive bladder cancer (NIMBC). Conclusions: mGPS may have the potential to predict recurrence in HG/G3 T1 NMIBC patients, but more prospective, with large cohorts, studies are needed to study the influence of systemic inflammatory markers in prediction of outcomes in NMIBC for a definitive conclusion
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