The impact of postoperative inflammatory biomarkers on oncologic outcomes of bladder cancer

S Albisinni; I Moussa; F Aoun; T Quackels; G Assenmacher; A Peltier; T Roumeguère

doi:10.1016/j.purol.2019.02.008

The impact of postoperative inflammatory biomarkers on oncologic outcomes of bladder cancer

Prog Urol. 2019 Apr;29(5):270-281. doi: 10.1016/j.purol.2019.02.008. Epub 2019 Apr 4.

Authors

S Albisinni¹, I Moussa², F Aoun³, T Quackels², G Assenmacher³, A Peltier³, T Roumeguère²

Affiliations

¹ University Clinics of Brussels, Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium. Electronic address: simone.albisinni@erasme.ulb.ac.be.
² University Clinics of Brussels, Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium.
³ Urology Department, Jules-Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 30954405
DOI: 10.1016/j.purol.2019.02.008

Abstract

Introduction: The clinical impact of inflammatory biomarkers has been evaluated in urothelial bladder cancer. However, data are limited to preoperative values and there is paucity of evidence of the role of postoperative measurement of those biomarkers. The aim of the current study was to determine the association of inflammatory biomarkers as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), hemoglobin to platelet ratio (HPR) and C-reactive protein (CRP), before and after radical cystectomy, with recurrence and survival of bladder cancer.

Material and methods: We prospectively evaluated 134 patients undergoing radical cystectomy for invasive bladder cancer between January 2013 and January 2018. The inflammatory biomarkers were measured 10days before surgery and at 1, 6 and 12months postoperatively. Kaplan-Meier curves and Cox proportional hazards and logistic regression models were used to evaluate the association between the different inflammatory biomarkers and recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS).

Results: The median follow-up time was 21.1months (5-37 mo). On multivariate analysis, preoperative NLR>3.88 was associated to locally-advanced disease (>pT3) and NLR>3.88 and HPR<0.039 were significantly associated to node positive disease. Postoperative NLR at 3months>4.68 (HR: 2.37, 95% CI: 1.08-4.47, P=0.03) was associated with a reduced RFS. A postoperative NLR at 3months>4.68 (P=0.04) and a postoperative HPR at 3months<0.029 (P=0.001) were associated with a significant reduction in CSS and OS.

Conclusion: Postoperative NLR and HPR at 3months appear to be closely associated with RFS, CSS and OS. Further studies are needed on these postoperative markers to establish the potential impact of these inflammatory biomarkers on a tailored therapeutic approach for each patient.

Level of evidence: 3.

Keywords: Bladder cancer; Cancer de la vessie; Inflammation; Recurrence; Récidive; Survie; Survival.

MeSH terms

Aged
Biomarkers, Tumor / analysis
Biomarkers, Tumor / blood*
Carcinoma, Transitional Cell / blood
Carcinoma, Transitional Cell / diagnosis
Carcinoma, Transitional Cell / pathology
Carcinoma, Transitional Cell / surgery*
Disease-Free Survival
Female
Follow-Up Studies
Humans
Inflammation / blood
Inflammation / diagnosis*
Inflammation / etiology
Male
Middle Aged
Neoplasm Recurrence, Local / diagnosis
Neoplasm Recurrence, Local / pathology
Postoperative Complications / blood
Postoperative Complications / diagnosis*
Postoperative Period
Predictive Value of Tests
Prognosis
Treatment Outcome
Urinary Bladder Neoplasms / blood
Urinary Bladder Neoplasms / diagnosis
Urinary Bladder Neoplasms / pathology
Urinary Bladder Neoplasms / surgery*

Substances

Biomarkers, Tumor