Association of Inflammatory and Nutritional Biomarkers with Pathological Response in Patients with Muscle-invasive Bladder Carcinoma Treated with Neoadjuvant Chemotherapy.

BACKGROUND

Bladder cancer is a prevalent urological malignancy, highlighting the need for prognostic biomarkers to optimise and individualise treatment strategies. This study aimed to assess the prognostic value of preoperative inflammatory and nutritional markers in patients with non-metastatic muscle-invasive bladder cancer (MIBC) treated with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC), focusing on pathological response and survival.

METHODS

This retrospective observational study included 133 patients with non-metastatic MIBC treated with NAC and RC between July 2011 and December 2024. Preoperative inflammatory and nutritional indices, including neutrophil/lymphocyte ratio (NLR), total lymphocyte count (TLC), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune inflammation index (SII) and nutritional prognostic index (NPI), were analysed and correlated with pathological response (complete, partial, or no response/progression).

RESULTS

Hematologic indices were associated with pathological response. Specifically, TLC (p <0.001), NLR (p = 0.002) and PLR (p = 0.006) were reduced in patients with cRP. Conversely, patients with elevated LMR values had a high percentage of complete pathological response (cPR) (p = 0.008). Elevated SII and low NPI were associated with poor pathological response (p <0.05) and survival. Patients with SII values below 535,000 showed higher mean survival compared with those with SII ≥ 535,000 (p <0.001), and patients with NPI ≥ 47 had a higher median survival compared with those with NPI <47 (p = 0.002).

CONCLUSIONS

Inflammatory and nutritional factors are key determinants in the response to NAC treatment in MIBC. Their use could optimise patient stratification and create new therapeutic opportunities.