Introduction

The role of cancer-related inflammation pathways as proxy of aggressiveness is well known in several cancers. Preoperative anemia and thrombocytosis are known to be associated with aggressive disease features in bladder cancer (BCa). Accordingly, we hypothesized that a single variable including hemoglobin (HB) and platelet count (PLT) (HB to PLT ratio [HPR]) could consider the synergic effect of both factors. We aim to evaluate if HPR can represent a predictor of cancer specific mortality (CSM) or overall mortality (OM) in patients treated with radical cystectomy (RC) for BCa

Methods

We evaluated 963 patients diagnosed with BCa and treated with RC between 1987 and 2015 at our institution. Routine laboratory measurements were performed preoperatively the day before surgery. Univariate and multivariable Cox proportional hazards regression analyses were used to predict CSM and OM. Covariates included age at surgery, gender, pathological T stage, pathological N stage, preoperative hydronephrosis, ASA score, surgical margins, lymph vascular invasion and neoadjuvant chemotherapy

Results

Median age was 69 years (IQR 62-75 years). HB was measured as g/L while PLT was measured as 10^9 L-1. Preoperative median HPR was 0.55 (IQR 0.41-0.70 ). Overall, 304, 129 and 540 patients were recorded with lymph node metastases, positive surgical margins and pT3-4 stage, respectively. CSM was observed in 385 (39%) patients, whereas OM was observed in 148 patients (48%). Median follow-up was 58 months (IQR 15-84 ). Patients with a HPR lower than 0.55 had adverse pathological characteristics, such as high grade (P < 0.001), advanced T stage (P < 0.001) and lymph node invasion (P < 0.001). At univariate analysis HPR higher than 0.55 was associated with lower risk of CSM and OM (respectively HR 0.224 and 0.291; CI 0.131-0.381 and 0.291-0.468; all p <0.001). At multivariate analysis preoperative HPR was associated with lower risk to incur CSM and OM (respectively HR 0.134 and 0.162; CI 0.05-0.37 and 0.07-0.41; all p <0.001). Other predictors of CSM were N stage and positive margins while neoadjuvant chemotherapy was inversely associated to CSM. Other predictors of OM were ASA score, age at surgery and N stage while neoadjuvant chemotherapy was inversely linked to OM

Conclusions

Despite the well known role of anemia and thrombocytosis as predictors of survival in BCa, HPR (that include both factors) should be considered as a powerful prognostic marker, expression of inflammation and of the disease aggressiveness. However further investigations are needed to fully understand the impact of inflammation in BCa

Funding

none