Clinical, pathological and inflammatory factors in prediction of intravesical BCG response in intermediate and high risk non muscle invasive bladder cancer

BCG (Bacillus Calmette Guerin) is currently the gold standard treatment option in non-muscle invasive bladder cancer (NMIBC) by reducing not only recurrence but also progression rates. However, the BCG response varies depending on many factors. In our study, besides clinicopathological factors; SII (Systemic immune-inflammation index), NLR (Neutrophil-lymphocyte ratio), PLR (Platelet-lymphocyte ratio) and LMR (Lymphocyte-monocyte ratio) values in predicting BCG response was examined. Between January 2010 and March 2023, 163 patients with NMIBC who were followed up by our clinic were included in the study. Demographic, clinical and pathological data of the patients, EAU risk group, pre-Tur-m NLR, PLR, LMR and SII values were analyzed. The patients were divided into two groups as BCG naive and refractory. Clinicopathological and inflammatory factors were compared between the groups. In addition, inflammatory parameters were compared by grouping them separately according to recurrence and progression. There was no significant difference between the groups in terms of gender, tumor stage and grade, multifocality , prostatic urethra and bladder neck involvement, histological subtype, and primary /recurrent disease. A higher rate of BCG refractory was observed in elderly patients (>65), those with a history of upper urinary tract tumor (UTUC), tumors with solid morphology and accompanying CIS , high-grade tumor in re- TURm , and patients in the high-risk group of EAU. SII, NLR, and PLR values were higher in the BCG refractory group than in BCG naive patients. SII cut The off value was determined as 561,9. CIS, UTUC history, solid tumor morphology, presence of high-grade tumor in re- TURm, high SII, NLR and PLR values may predict BCG response, recurrence and progression. In these patient groups, radical curative treatment options may be preferred rather than intravesical BCG treatment. Key words: Bladder Cancer, BCG Response, İnflammatory Factors, BCG Refractor