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Published on: May 19, 2022
Postoperative Neutrophil-to-Albumin Ratio as a Prognostic Marker for Patients with Bladder Cancer Undergoing Radical
Wei Li1, Chenhui Xiang1, Guoping Xie1
1Department of Urology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.
Objective:
This study aimed to investigate the prognostic value of the postoperative neutrophil-to-albumin ratio (NAR) in patients with bladder cancer undergoing radical cystectomy.
Patients And Methods:
A total of 368 patients with histologically confirmed bladder cancer who underwent radical cystectomy between January 2018 and December 2021 were retrospectively analyzed. Postoperative NAR was calculated using neutrophil count (%) and serum albumin concentration (g/L) measured approximately three months after surgery. Receiver operating characteristic analysis identified the optimal NAR cutoff value for predicting 5-year overall survival. Kaplan-Meier and Cox regression models were used to assess associations between NAR and overall survival or recurrence-free survival.
Results:
The optimal NAR cutoff value was 2.6 with an AUC value of 0.76. Elevated NAR was significantly correlated with bladder cancer of invasive pathological types (p = 0.005), advanced tumor stage (p < 0.0001), lymph-node metastasis (p = 0.002), and receipt of neoadjuvant chemotherapy (p = 0.014). Patients with elevated NAR had significantly shorter overall survival (HR=3.14; 95% CI, 1.27-6.24; p = 0.002) and recurrence-free survival (HR=3.27; 95% CI, 1.52-5.87; p = 0.001) compared with those with low NAR. In multivariate analysis, postoperative NAR (p = 0.001), tumor stage (p = 0.002), and pathological type (p = 0.013) were independent predictors of overall survival, while NAR (p = 0.002), tumor stage (p = 0.003), and lymph-node metastasis (p = 0.014) independently predicted recurrence-free survival.
Conclusion:
An increased postoperative NAR independently predicts poorer overall and recurrence-free survival of bladder cancer patients following radical cystectomy. As an inexpensive and readily available biomarker reflecting systemic inflammation and nutritional status, NAR may serve as a practical tool for postoperative risk stratification and individualized patient management.