Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

Yidi Wang; Keyi Wang; Jinliang Ni; Houliang Zhang; Lei Yin; Yifan Zhang; Huajuan Shi; Tao Zhang; Naichun Zhou; Weipu Mao; Bo Peng

doi:10.3389/fonc.2021.762470

Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

Front Oncol. 2021 Dec 2:11:762470. doi: 10.3389/fonc.2021.762470. eCollection 2021.

Authors

Yidi Wang^{1

2}, Keyi Wang^{1

2}, Jinliang Ni^{2

3}, Houliang Zhang², Lei Yin², Yifan Zhang², Huajuan Shi¹, Tao Zhang¹, Naichun Zhou⁴, Weipu Mao⁵, Bo Peng^{1

2

3}

Affiliations

¹ Department of Urology, Shanghai Putuo District People's Hospital, Tongji University, Shanghai, China.
² Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Shanghai Clinical College, Anhui Medical University, Hefei, China.
⁴ Department of Urology, Xinyang Central Hospital, Xinyang, China.
⁵ Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.

Abstract

Background: Inflammation is widely considered an important hallmark of cancer and associated with poor postoperative survival. The objective of this study is to assess the significance of preoperative C-NLR, a new inflammation-based index that includes preoperative C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), on therapeutic outcomes for bladder cancer (BC) patients after radical cystectomy (RC).

Materials and methods: BC patients who underwent RC between 2010 and 2019 were retrospectively analyzed from our medical center. The predictive effect of CRP, NLR, and C-NLR on the survival of BC patients were analyzed by the receiver operating characteristic (ROC) curves. The relationship between C-NLR and postoperative survival was investigated by Cox regression. The corresponding nomograms were built based on the Cox regression results of overall survival (OS) and disease-free survival (DFS), which were further validated by ROC curves, decision curve analysis (DCA) curves, and calibration curves.

Results: Of the 199 eligible patients, 83 (41.70%) were classified as high C-NLR group and the remaining 116 (58.30%) were classified as low C-NLR group. ROC analysis showed that C-NLR had the largest area under curve (AUC) compared to CRP and NLR. Multivariate analysis revealed that T-stage and C-NLR [high C-NLR vs. low C-NLR, hazard ratio (HR) = 2.478, 95% confidence interval (CI), 1.538-3.993, p < 0.001] were independent predictors of OS, whereas T-stage, M-stage, and C-NLR (high C-NLR vs. low C-NLR, HR = 2.817, 95% CI, 1.667-4.762, p < 0.001) were independent predictors of DFS. ROC and DCA analysis demonstrated better accuracy and discrimination of 3- and 5-year OS and DFS with C-NLR-based nomogram compared to TNM stage. The calibration curve reconfirmed the accurate predicting performance of nomograms.

Conclusion: C-NLR is a reliable predictor of long-term prognosis of BC patients after RC and will contribute to the optimization of individual therapy for BC patients.

Keywords: C-reactive protein; bladder cancer; neutrophil-to-lymphocyte ratio; nomogram; prognosis; radical cystectomy.