The Impact Of Prognostic Nutritional Index And Preoperative Neutrophil-lymphocyte Ratio In Non-muscle Invasive Bladder Cancer

Background and purposesRecent studies have shown that immune status and the systemic inflammatory response are closely related to tumor development.Prognostic nutrition index(PNI),a preoperative parameter used to evaluate immune status,nutrition,and operation risk,isvaluable in predictingthe prognosis in gastric and esophageal cancers.In addition,preoperative neutrophil-lymphocyte ratio(NLR)is the biomarker of the systemic inflammatory response,which has been proved to be related to kinds of malignancies,including lung cancer,gastric cancer.PNI and NLR have been proved to be independent predictors for patients with bladder cancer after radical cystectomy.However,no study has elaborated on the correlation between RFS and PNI as well as inflammation-based markers in patients with non-muscle invasive bladder cancer(NMIBC).In general,approximately 75%of bladder cancer are non-muscle invasive.Besides,up to 70%of them eventually undergo recurrence and 10-20%of them experience progression to muscle invasive blader cancer.Therefore,effective indicators are needed for treatment decision and individualized follow-up.This study aimed to explore the prognostic values of preoperative PNI and NLR in NMIBC.Moreover,whether the combination of PNI and NLR has better prognostic values than that of either index alone was investigated.PurposeTo evaluate the prognostic values of preoperative prognostic nutritional index(PNI)and neutrophil-lymphocyte ratio(NLR)in patients with non-muscle invasive bladder cancer(NMIBC).MethodsFrom January 2013 to March 2017,the data on 202 patients newly diagnosed with NMIBC were retrospectively analyzed.The best critical values of PNI and NLR,recurrence-free survival(RFS),and independent risk factors were analyzed through receiver-operating characteristic curve(ROC),Kaplan-Meier curve,and Cox regression model,respectively.ResultsROC analysis suggested that the optimal cut-off points of the PNI and NLR were 48.5 and 2.20,respectively.The low-PNI group was remarkably correlated with age,gender,smoking habit,histological grade,and T stage(P<0.05).The high-NLR was significantly related to tumor number,tumor size,histological grade,and T stage(P<0.05).Survival analysis showed that RFS in patients with high-PNI or low-NLR was significantly longer than those in the low-PNI or high-NLR group.Univariate analysis revealed that age,smoking history,tumor size,tumor number,T stage,histological grade,PNI and NLRcould be the predictors of RFS(P<0.05).However,further multivariate Cox regression analysis identified only PNI(P=0.002),NLR(P=0.005),and T stage(P=0.002)as independent prognostic factors correlated with RFS.ConclusionOur results suggest that PNI and NLR are potential parameters for predicting the RFS of patients with NMIBC.