Introduction

We have previously reported smoking status (2015 AUA) and an elevated preoperative neutrophil-to-lymphocyte ratio (pre-NLR) (2016 AUA) were predictive factors for tumor recurrence in overall non-muscle invasive bladder cancer (NMIBC) cases. However, there are still no reliable indicators for identifying BCG relapsing tumor recurrence in NMIBC patients treated with BCG therapy. We examined here whether elevated pre-NLR and/or smoking status could be associated with BCG relapsing tumor recurrence.

Methods

We identified 1759 cases treated by TURBT for initially diagnosed NMIBC between 1999 and 2015 at our 4 institutions. Detailed information concerning smoking status and a full set of blood data were available for 947 of these 1759 cases. After excluding patients who were BCG refractory and BCG intolerant, 438 cases treated with BCG therapy were included in the present study. We evaluated the predictive factors for identifying BCG relapsing tumor recurrence, defined as recurrence after achieving a disease-free status by initial BCG instillations for 6 months. We assigned patients to the elevated pre-NLR group using a cut-off of NLR of more than 2.095 according to a calculation by receiver-operating curve analysis.

Results

A total of 208 patients (47.5%) had elevated pre-NLR and 264 patients (60.3%) had a previous history of smoking. Patients with elevated pre-NLR were significantly older and had higher tumor stage as compared to their counterparts. A higher population of male patients was observed in the smoker group. The 5-year recurrence free survival (RFS) rate in patients with elevated pre-NLR was 63.2 ± 3.7%, which was significantly lower than that in those without elevated pre-NLR (77.9 ± 3.0%, p<0.001). The 5-year RFS rate in patients with a previous history of smoking was 66.0 ± 3.3%, which was significantly lower than that in that in the non-smoker group (78.2 ± 3.4%, p=0.003). Multivariate analysis demonstrated that an elevated pre-NLR (hazard ratio: HR, 1.98, p<0.001) and a previous history of smoking (HR, 1.81, p=0.003) were independently associated with BCG relapsing tumor recurrence.

Conclusions

Pre-NLR level and smoking status before BCG therapy might be useful information for predicting BCG relapsing tumor recurrence. Patients with a high pre-NLR level and positive smoking history are highly recommended to undergo early cystectomy due to their higher rate of BCG relapsing tumor recurrence.

Funding

none