Relationship between prognostic nutritional index and inflammatory markers and response in bladder cancer patients receiving neoadjuvant chemotherapy

Bladder cancer is one of the most common malignancies of the urinary system leading to high mortality rates worldwide. The aim of this study is to investigate the importance of PNI, which is accessible, reproducible, easy to calculate, and affordable, as well as other inflammatory markers in the prognosis of bladder cancer. In this study, patients with muscle-invasive bladder cancer who underwent neoadjuvant treatment at Trakya University Medical Oncology Clinic between January 1, 2012, and June 1, 2023, were retrospectively evaluated. All patients whose medical records were available were included in the evaluation. Patients with comorbidities such as infection, hematological disease, rheumatological disease, hypothyroidism, hepatitis, cirrhosis, or malnutrition, which may cause an increase in serum lymphocyte values and a decrease in albumin value, were excluded from the study. Lymphocyte and albumin values of all patients at the time of diagnosis were recorded. Age, gender, date of operation, metastasis status, pathological findings, treatment, response to treatment, and recurrence/progression date were recorded. 30 patients for whom all data were available were included in the study. It was planned to evaluate the effect of prognostic nutritional index (PNI) on radiological and pathological complete response and survival in patients receiving neoadjuvant treatment and whether it can be used as a prognostic factor. Receiver Operating Characteristics (ROC) analysis was used to determine the discrimination of the Prognostic Nutritional Index according to the stage change after neoadjuvant chemotherapy. An alternative categorisation was created using a predictive value of 54.55 calculated using the Youden index. According to this categorisation, low PNI group was defined as below ≤54.55 PNI value and high PNI group was defined as above 54.55 PNI value and radiological and pathological responses after neoadjuvant chemotherapy were compared. In our study, 30 patients with bladder cancer were analysed. Of these patients, 24 (80.0%) were male. The mean age at diagnosis was 66.97±8.38 years and the mean age was 65.88±7.08 years for males and 71.33±12.19 years for females. Most of the patients were exposed to cigarettes and 23 (76.7%) of them had a history of smoking. At the time of diagnosis, 12 (40.0%) patients were stage 2, 12 (40.0%) were stage 3A, and 6 (20.0%) were stage 3B. Twenty-one (70.0%) of the patients underwent radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and 9 (30.0%) patients did not accept RC and received chemoradiotherapy (CRT). The median progression-free survival was 25.40 (95% CI 6.19-44.61) months and median overall survival was 61.87 (95% CI 37.83-85.91) months. ROC analysis was performed to predict survival according to PNI score and according to the cut-off value determined using the Youden index (low PNI group below PNI value ≤54.55 and high PNI group above PNI value 54.55), there was a positive numerical difference between PNI value and PFS and OS, but no statistically significant difference (p=0.061 and p=0.145, respectively). PNI is an affordable, easily calculated, reproducible, noninvasive biomarker and has been established to evaluate the inflammatory and nutritional status of patients. Considering the limitations of our study, we believe that larger studies should be conducted, but our results suggest that PNI levels measured before treatment can be used as a prognostic guide in muscle-invasive bladder cancer patients.