Evaluation of effect of preoperative inflammation markers on the prognosis of non-muscle invasive bladder tumors

Introduction: Bladder cancer is the 7th most common cancer in men, 17th most common in women, and it is an important public health problem because of its incidence, high recurrence rate and requirement for lifelong follow-up. Disease management in muscle non-invasive bladder cancer are performed according to the risk classification of the disease. Today, the risk classification table of the European Organization for Research and Treatment (EORTC) is used. Risk classification is performed according to clinical and pathological factors and there is no biochemical marker currently in use. In this context, inflammation has an important role in the development and progression of many malignancies. In our study, we aimed to investigate the relationship between the preoperative inflammatory markers and the pathologic features of the tumor, recurrence and progression in the follow-up of patients with non-muscle invasive bladder tumor. Material and Methods: 106 patients who admitted to the urology clinic between July 2017 and August 2018 and diagnosed with mass lesion in bladder are included in our study. The blood samples are collected from patients before TURB and NLR, LMR, PLR, RDW, MPV, CRP, Albumin and Globulin values were calculated. The effect of preoperative inflammatory parameters and other clinical and pathological parameters on recurrence and progression rates were evaluated. Results: We evaluated all non-metastatic bladder tumor patients, only CRP was found to be valuable in predicting the disease stage (p = 0.017). There was no statistically significant relationship between preoperative laboratory values and other variables such as pathological degree of tumor, presence of concomitant CIS, size and number of tumors. In analyses performed for NMIBC cases, NLR was statistically significantly associated with both recurrence (p = 0.01) and progression (p = 0.035) whereas LMR was only associated with recurrence (p = 0.038). In the survival analysis, the relationship between recurrence and LMR was confirmed in both univariate (p = 0.021) and multivariate (p = 0.022) analyzes. The relationship between NLR and recurrence was confirmed in univariate analysis (p = 0.019), but in multivariate analysis was found to be statistically insignificant (p = 0.051). Sub-group analyzes were performed for low, medium and high risk groups according to EAU guidelines. There was no significant relationship between recurrence and progression in low and medium risk groups, but NLR and LMR were associated with disease recurrence in high-risk patients(p = 0.016, p = 0.021). Conclusion: Lymphocyte/monocyte ratio is an easy obtainable, non-invasive and cost-effective method for predicting recurrence and progression of disease in patients with non-muscle invasive bladder cancer. Randomized, prospective studies are needed in larger patient groups on this issue, due to conflicting results in the literature.