Clinical Significance Of Preoperative Inflammatory Markers In The Diagnosis And Prediction Of Bladder Cancer And T Staging

Objective:To investigate the preoperative peripheral blood based inflammatory index neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR),platelet/lymphocyte ratio(PLR),red cell distribution width(RDW),and Albumin for diagnosis and prediction of urinary bladder cancer(UBC)and clinical significance of T staging.Methods:A total of 205 UBC patients(group A,bladder cancer group)and 62 healthy subjects(group B,healthy control group)who underwent surgery from Yanbian University Affiliated Hospital fromDecember 2017 to January 2019were enrolled.Absolute values of neutrophils,lymphocytes,monocyte,platelet count,RDW value,and Albumin content were calculated.To identify the correlation between preoperative hematological parameters(NLR,MLR,PLR,RDW,and Albumin),T-stage,and tumor size Kruskal-Wallis and Mann-Whitney U test analysis were applied.Tumor size of UBC were categorized in to two groups(>3cm and<3cm)and explore the correlation between above mentioned hematological indexes and T stages.Jonckheere-Terpsta method was applied to assess the correlation between T clinical stage of CUB patient and hematological indexes.Receiver operating characteristic curve(ROC)analysis was plotted to determine the optimal cutoff value,sensitivity,and specificity for predicting and diagnosing UBC.To detect the independent predicting factor multivariate logistic regression analysis was performed.Result:1.Compared with the healthy group,the mean values of preoperative inflammatory markers in the CUB group werel.55 versus(vs)3.90 for NLR,6.37 vs 4.19 for MLR,103.35 vs 162.28 for PLR,and 12.85 vs 13.26 for RDW and 41.5 vs 35.5 foe Albumin.Both group had statistically significant differences(all P<0.05).2.Kruskal-Wallis and Mann-Whitney U test results:UBC tumor grade,tumor size and NLR(P<0.001),PLR(P<0.029),MLR(P<0.046),RDW(P<0.044),and albumin(P<0.001)were all correlated.3.Jonckheere-Terpsta test results:T stage was positively correlated with NLR,PLR,and RDW(P<0.01),indicating an increase in these value with the increase of T stages(P=0.01),and T stages were negatively correlated with MLR,and albumin,both of which had significant compliance effects(P<0.001).4.ROC curve analysis showed that the optimal threshold(cut-off value),sensitivity and specificity of peripheral blood based indexes for predicting and diagnosing of UBC were 1.84,89%and 79%for NLR,135.03,54%and 90%for PLR,431,66%and 85%for MLR,13.05,34%and 83%for RDW,and 36.05,45%and 98%for Albumin respectively.5.Multivariate logistic regression analysis showed that NLR≥1.84(P<0.001)and MLR≥4.31 P<0.005 were independent predictors of UBC diagnosis.Conclusion:1.Preoperative inflammatory index NLR≥1.84,MLR≥4.31,and albumin<36.05g/L could be the new convenient and easy independent preoperative inflammatory indicators for prediction and for diagnosis of UBC as well.2.As the T fraction increases NLR,PLR and RDW also increase,while MLR and albumin decrease along with increasing T stages.There is a significant correlation with among this clinical index,so NLR,PLR,RDW and albumin could be used as new indicators for preoperative prediction of UBC T staging.