Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker of Tumor Grade in Non–Muscle-Invasive Bladder Cancer: A Prospective Cross-Sectional Study
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1500Abstract
Background: Non–muscle-invasive bladder cancer (NMIBC) accounts for the majority of newly diagnosed bladder tumors and is associated with high recurrence and progression rates. The neutrophil-to-lymphocyte ratio (NLR), a readily available marker of systemic inflammation, has emerged as a potential prognostic biomarker in urothelial carcinoma.
Objective: To evaluate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and tumor grade in patients with newly diagnosed NMIBC.
Methodology: This prospective cross-sectional analytical study was conducted at a tertiary care center from July 2025 to December 2025. Adult patients (≥18 years) with histologically confirmed NMIBC undergoing transurethral resection of bladder tumor (TURBT) were included. Patients with muscle-invasive disease, prior bladder cancer treatment, active infections, autoimmune disorders, or other confounding conditions were excluded. Preoperative complete blood counts were used to calculate NLR. Tumor characteristics and histopathological grading were recorded. Statistical analysis was performed using SPSS version 26.0, with p < 0.05 considered statistically significant.
Results: A total of 71 patients were included, with a mean age of 56.3 ± 12.7 years. Low-grade NMIBC was observed in 53 patients (74.6%), while 18 patients (25.4%) had high-grade tumors. Median preoperative NLR was significantly higher in the high-grade group compared to the low-grade group [3.7 (IQR 3.2–4.1) vs 2.4 (IQR 2.0–2.8); p < 0.001]. An NLR cutoff value of 3.0 demonstrated acceptable discriminatory ability for predicting high-grade NMIBC (AUC = 0.76; 95% CI: 0.65–0.87; p < 0.01).
Conclusion: Elevated preoperative neutrophil-to-lymphocyte ratio (NLR ≥3) is significantly associated with high-grade NMIBC and may serve as a simple, cost-effective biomarker for identifying patients with aggressive disease at diagnosis.
Keywords: Biomarkers, Lymphocyte, Neutrophil, Transitional cell carcinoma, Urinary bladder carcinoma.
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