Validation of neutrophil-to-lymphocyte ratio for prognosis and treatment selection in muscle-invasive bladder cancer: A single-institutional longitudinal study

Purpose: To evaluate the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) in patients with muscle-invasive bladder cancer (MIBC) and its potential in guiding treatment strategies between radical cystectomy (RC) and trimodal therapy (TMT). Materials and methods: This retrospective cohort study included 207 patients diagnosed with MIBC between January 2012 and December 2018. After applying exclusion criteria, 116 patients were analyzed. Preoperative NLR values were recorded, and patients were categorized into high NLR (NLR > 3) and low NLR (NLR ≤ 3) groups. Survival outcomes, including recurrence rate, disease-free survival, and overall survival, were analyzed. Cox regression models and Kaplan-Meier survival curves were used to assess the prognostic significance of NLR. Results: The study comprised 87 men and 29 women with a mean age of 67.7 ± 10.8 years. High NLR was associated with shorter time to recurrence (15.38 ± 12.76 versus 22.86 ± 14.79 mo, P = 0.046) and higher mortality rates (50% versus 29.7%, P = 0.026). Patients with lower NLR who underwent RC demonstrated better disease-free survival compared with those with higher NLR (log-rank test: P = 0.01). Subgroup analysis also revealed that low NLR in TMT patients was associated with significantly longer time to recurrence. Multivariate analysis identified advanced tumor staging as a major predictor of recurrence and death, while overweight status was a protective factor. Conclusion: Elevated NLR is associated with poorer outcomes in MIBC and may help stratify patients for treatment decisions between RC and TMT. NLR may be particularly useful in predicting recurrence risk and informing posttreatment surveillance intensity.