Preoperative hemoglobin-platelet ratio can significantly predict progression and mortality outcomes in patients with T1G3 bladder cancer undergoing transurethral resection of bladder tumor

// Gang Tang 1, 2 , Yunpeng Zhen 1, 2 , Wanqin Xie 3 , Yinlei Wang 1, 2 , Feiran Chen 1, 2 , Chuan Qin 1, 2 , Han Yang 1, 2 , Zhiyong Du 1, 2 , Zhonghua Shen 1, 2 , Bo Zhang 1, 2 , Zhouliang Wu 1, 2 , Dawei Tian 1, 2 and Hailong Hu 1, 2 1 Department of Urology, The Second Hospital of Tianjin Medical University, Hexi District, Tianjin 300211, China 2 Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China 3 Key Laboratory of Genetics and Birth Health of Hunan Province, The Family Planning Research Institute of Hunan Province, Changsha, Hunan 410126, China Correspondence to: Dawei Tian, email: jianshi001@126.com Hailong Hu, email: hhllove2004@163.com Keywords: HPR; T1G3 bladder cancer; PFS; OS; CSS Received: June 28, 2016      Accepted: November 12, 2017      Epub: January 03, 2018      Published: April 06, 2018 ABSTRACT Objective: To investigate the prognostic role of hematological biomarkers, especially hemoglobin-platelet ratio (HPR) in the oncological outcomes in stage 1 and grade 3 (T1G3) bladder cancer. Materials and Methods: We identified 457 T1G3 bladder cancer patients who underwent transurethral resection of the bladder (TURB) between 2009 and 2014. Based on hematological parameters (hemoglobin-platelet ratio (HPR), hemoglobin, and platelet counts), recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) and cancer-specific survival (CSS) were analyzed by using Kaplan-Meier analysis. Multivariate Cox regression model was adopted to identify the predictors of oncological outcomes. Results: Kaplan-Meier survival analysis showed that low HPR ( 240 x 103/μl) were correlated with poor OS. Low HPR, but not low hemoglobin and high platelet counts, is associated with worse PFS. Low HPR and low hemoglobin, but not elevated platelet counts, are associated with worse CSS. However, no significant difference was observed in RFS according to any of these hematological markers. On multivariate analysis, low HPR (HR = 1.27, 95% CI = 0.81–1.75, P = 0.030), low hemoglobin (HR = 1.20, 95% CI = 0.79-1.84, P = 0.028) and elevated platelet counts (HR = 1.07, 95% CI = 0.72–1.32, P = 0.038) were significantly associated with OS. Low hemoglobin (HR = 1.08, 95% CI = 0.68–1.82, P = 0.041) was significantly linked with CSS. Particularly, low HPR was identified as an independent predictor of PFS (HR = 1.16, 95%CI = 0.97–1.49, P = 0.033) and CSS (HR = 1.14, 95% CI = 0.87-1.78, P = 0.029). Conclusions: Preoperative HPR can be taken into account as a factor predictive of oncological outcomes for T1G3 bladder cancer, particularly disease progression and mortality outcomes.