Mean platelet volume to lymphocyte ratio as an inflammatory marker associated with high-grade recurrence and progression of non-muscle-invasive bladder cancer treated with Bacillus Calmette-Guérin.

INTRODUCTION

To assess the value of a novel inflammatory marker involving the ratio between mean platelet volume and lymphocyte counts (MPVL) in the prediction of high-grade recurrence-free survival (HG RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC) treated with adjuvant Bacillus Calmette-Guérin (BCG) therapy.

MATERIAL AND METHODS

In this retrospective, single tertiary centre study the medical records of 216 consecutive patients with NMIBC, who received BCG between 2010 and 2019, were reviewed. Kaplan-Meier curves and Cox proportional hazard regression were used for survival analysis.

RESULTS

We included 194 patients who underwent transurethral resection of a bladder tumour and received at least an induction course of BCG. The majority of patients presented with high-grade T1 tumours (n = 114, 59%). Within a median follow-up of 65 months (IQR: 27-93), 35 patients (18%) experienced progression, and 69 (34.5%) had a high-grade recurrence. Kaplan-Meier analyses revealed a significant association between higher MPVL and worse PFS and HG RFS (both p <0.05). Specifically, patients with higher MPVL demonstrated decreased 5-year PFS (75% vs 90%) and HG RFS (54.5% vs 75%) compared to lower MPVL counterparts. Multivariate analyses confirmed the independent prognostic value of MPVL for HG RFS (HR = 1.7, p = 0.047) and PFS (HR = 2.37, p = 0.026).

CONCLUSIONS

In patients with NMIBC treated with adjuvant BCG, an elevated inflammatory marker comprising mean platelet volume and lymphocyte count ratio may serve as a prognostic factor associated with worse PFS and HG RFS. The role of MPVL in clinical decision-making must be validated in further multicentre prospective studies.