The prognostic value of hematological and systemic inflammatory disorders in invasive bladder cancer

In contrast to the large amount of evidence reporting on the oncological significance of various clinicopathological and molecular parameters for survival in invasive bladder cancer, alterations of preoperative hematological and systemic inflammatory parameters have not been sufficiently addressed in the literature so far.

Pretreatment serum C-reactive protein was recently incorporated in a new outcome prediction model, termed Tumor Node Resection C-reactive protein score, and demonstrated a significant increase in the predictive accuracy of standard pathologic risk factors for cancer-specific survival after radical cystectomy. The presence of preoperative thrombocytosis is associated with multiple hematologic disorders in invasive bladder cancer and higher tumor aggressiveness suggesting that platelets play a role in tumor growth and metastasis formation. In patients undergoing second-line chemotherapy for metastatic disease, pretreatment lower hemoglobin level was identified as an independent prognostic factor for overall survival.

The degree of systemic inflammation and hematological disorders in invasive bladder cancer is often associated with more aggressive disease. The incorporation of hemoglobin levels, serum C-reactive protein and platelet counts into current nomograms might improve significantly the predictive accuracy of standard clinicopathological risk factors and provide improved prognostication for counseling more selectively the use of chemotherapy in the neoadjuvant, adjuvant and metastatic setting.