Prognostic effect of preoperative albumin-to-globulin ratio in patients with non-metastatic bladder cancer undergoing radical cystectomy

Introduction: Blood-based inflammatory and nutritional biomarkers have been crucial prognostic indicators in various malignancies. This study aimed to investigate the association of preoperative biomarkers with postoperative outcome in patients with non-metastatic bladder cancer (clinical stage ≤IIIb) who underwent radical cystectomy (RC). Methods: This study retrospectively analyzed data, including preoperative albumin-to-globulin ratio (AGR), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein-to-albumin ratio (CAR), of 235 patients with non-metastatic bladder cancer who underwent RC at 10 Kitasato University-affiliated hospitals between 2002 and 2023. Results: Survival analyses revealed the significant association of low AGR with poorer 5-year disease-free survival (DFS) (31% vs. 64%, p < 0.001) and overall survival (OS) (44% vs. 70%, p < 0.001). High NLR correlated with DFS (53% vs. 72%, p = 0.008) and OS (59% vs. 79%, p = 0.009), whereas high CAR was significant only for OS (39% vs. 60%, p = 0.001). Multivariable analysis demonstrated that low AGR was significantly associated with poorer DFS (hazard ratio [HR]: 1.75; 95% confidence interval [CI] : 1.02–2.98; p = 0.041) and OS (HR: 1.83; 95% CI: 1.04–3.22; p = 0.037). Conclusion: Preoperative blood-based biomarkers may help identify patients at high risk of non-metastatic bladder cancer after RC. In particular, AGR provides a simple, inexpensive, and widely applicable tool for risk stratification and treatment planning.