Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

Background: Inflammation is widely considered an important hallmark of cancer and associated with poor postoperative survival. The objective of this study is to assess the significance of preoperative C-NLR, a new inflammation-based index that includes preoperative C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), on therapeutic outcomes for bladder cancer (BC) patients after radical cystectomy (RC). Materials and methods: BC patients underwent RC between 2010 and 2019 were retrospectively analyzed from our medical center. The predictive effect of CRP, NLR, and C-NLR on the survival of BC patients were analyzed by the receiver operating characteristic (ROC) curves. And the relationship between C-NLR and postoperative survival was investigated by cox regression. The corresponding nomograms were built based on the cox regression results of overall survival (OS) and disease-free survival (DFS), which were further validated by ROC curves, decision curve analysis (DCA) curves and calibration curves. Results: Of the 199 eligible patients, 83 (41.70%) were classified as high C-NLR group and the remaining 116 (58.30%) as low C-NLR group. ROC analysis showed that C-NLR had the largest area under curve (AUC) compared to CRP and NLR. Multivariate analysis revealed that T-stage and C-NLR (high C-NLR vs. low C-NLR, hazard ratio (HR) = 2.478, 95% confidence interval (CI), 1.538-3.993, P < 0.001) were independent predictors of OS, whereas T-stage, M-stage and C-NLR (high C-NLR vs. low C-NLR, HR = 2.817, 95% CI, 1.667-4.762, P < 0.001) were independent predictors of DFS. ROC and DCA analysis demonstrated better accuracy and discrimination of 3- and 5-year OS and DFS with C-NLR-based nomogram compared to TNM stage. The calibration curve reconfirmed the accurate predicting performance of nomograms. Conclusion: C-NLR is a reliable predictor of long-term prognosis of BC patients after RC and will contribute to preoperative decision-making of RC and improve individualized treatment in BC patients.