Abstract
PurposeThis study aimed to assess the prognostic value of the lymphocyte–C-reactive protein ratio (LCR) in patients with bladder cancer (BCa) who underwent radical cystectomy (RC).Materials and MethodsBCa patients between 2009 and 2018 were retrieved from our medical center. The predictive value of LCR on survival of BCa patients was evaluated through the Kaplan–Meier survival and receiver operating characteristic (ROC) curves. The multivariate Cox regression results were used for conducting the nomogram, which were further verified by ROC, decision curve analysis (DCA), and calibration curves. Propensity score matching (PSM) was performed to validate our findings.ResultsA total of 201 BCa patients who received RC were included in this study, with 62 (30.8%) patients in the low LCR group and 139 (69.2%) in the high LCR group. Multivariate analysis results revealed that the high LCR group was significantly related to better prognosis and functioned as a prognostic biomarker for overall survival (OS) [hazard ratio (HR) = 0.41, 95% CI, 0.26–0.66; p < 0.001] and disease-free survival (DFS) [HR = 0.40, 95% CI, 0.26–0.66; p < 0.001]. The nomogram processed better predictive capability and accuracy than TNM stage from ROC results (AUC = 0.754 vs. AUC = 0.715), with the confirmation of calibration curves and DCA. The result of PSM confirmed that LCR was significantly correlated with OS and DFS.ConclusionOur finding demonstrates that LCR is a novel, convenient, and effective predictor that may provide vital assistance for clinical decision and individualized therapy in BCa patients after RC.
Highlights
Bladder cancer (BCa) has become a common cancer, ranking ninth in morbidity and 13th in mortality among malignancies worldwide [1]
Sixty-two (31%) patients were stratified into the low lymphocyte to serum CRP (LCR) group, and 139 (69%) patients were distributed into the high LCR group
The low LCR group was older than the high LCR group and was significantly associated with low body mass index (BMI) (75.8% vs. 52.5% p = 0.002)
Summary
Bladder cancer (BCa) has become a common cancer, ranking ninth in morbidity and 13th in mortality among malignancies worldwide [1]. TNM staging is widely used in clinical staging of BCa, in which Tis, Ta, and T1 BCas are collectively considered as non-muscular invasive BCa (NMIBC), and T2 or above BCas are considered as muscular invasive BCa (MIBC) [2]. The survival rates are still not satisfactory after RC treatment. TNM staging is one of the most valuable indicators to judge the clinical prognosis, the clinical outcome for patients after RC may vary even with similar stage and grade of BCa. Except for the heterogeneous characteristic of BCa, initial under-staging is an important risk factor of disease progression and poor outcomes [4, 5]. It is important and reasonable to seek effective approaches to enhance clinical decision determination and assist clinicians to identify appropriate surgical interventions and treatments for patients during the perioperative course
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