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Original Research

Open Access

Validation of the importance of neutrophil-to-lymphocyte ratio in non-muscle invasive bladder cancer

  • Porav-Hodade Daniel1
  • Balan Daniel1
  • Reman Tibor1
  • Balan-Bernstein Noemi2
  • Vida Arpad Oliver1
  • Martha Orsolya1

1Department of Urology, University of Medicine, Pharmacy, Science and Technology ''George Emil Palade'' of Targu-Mures, 540139 Târgu Mureș, Romania

2Department of Pneumology, University of Medicine, Pharmacy, Science and Technology ''George Emil Palade'' of Targu-Mures, 540139 Târgu Mureș, Romania

DOI: 10.31083/jomh.2021.128

Submitted: 21 July 2021 Accepted: 13 September 2021

Online publish date: 26 September 2021

*Corresponding Author(s): Balan Daniel E-mail:

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Background and objective: Since the peritumoral inflammatory reaction is of considerable importance in the oncological prognosis of bladder cancer, the neutrophil-to-lymphocyte ratio (NLR) may be a very practical and accessible biomarker in non-muscle invasive bladder tumors. This study aims to analyze parameters of non-muscle invasive bladder tumors and to identify and validate potential tumor markers with a prognostic role in this condition.

Material and methods: 463 patients diagnosed with non-muscle invasive urothelial tumors, between January 2016 and June 2020, hospitalized at the Urology Clinic in Târgu Mureș, after transurethral resection of bladder tumor (TURBT) were investigated. Inclusion criteria were: non-muscle invasive tumors (Ta, T1, CIS), neutrophil-to-lymphocyte ratio (NLR) determination 2 weeks prior to TURBT and complete follow-up of patients. NLR cut-off was set at 3.

Results: 371 people diagnosed with non-muscle invasive bladder tumors met the inclusion criteria. The mean age of the included patients was 69.96 years (IQR 35–93). 297 (80.05%) were male and 74 (19.95%) were female. 64.95% pTa tumors, 31.26% pT1, 1.07% pTa + CIS, and 2.69% pT1 + CIS, respectively, were identified. Distribution according to Grade: 196 (52.8%) G2, 159 (42.88%) G3 and 16 (4.32%) CIS. 284 (76.5%) patients presented with a single tumor and 87 (23.35%) with multiple tumors; 295 (79.5%) had tumors larger than 3 cm and 76 (20.5%) smaller than 3 cm. 228 (61.4%) presented with recurrence after 3 months after surgery. Overall survival at 5 years was 80.06%. Advanced age at the time of diagnosis correlated with low survival, p = 0.004. The mortality rate was higher among men (20.54%) than among women (17.58%). Statistically, there was a positive relationship between the increased ratio of neutrophils and lymphocytes in people diagnosed with non-muscle invasive bladder cancer and increased mortality rate, p = 0.003.

Conclusions: The overall survival of patients with non-muscle invasive bladder cancer was negatively influenced by the advanced age of the patients at the time of diagnosis. Increased preoperative NLR was associated with a higher mortality rate in patients with non-muscle invasive bladder cancers. This assay is an accessible, easy to performand useful biomarker in the prognosis of non-muscle invasive bladder tumors.


Neutrophil-to-lymphocyte ratio; Non-muscle invasive bladder cancer; Overall survival; Biomarker

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Porav-Hodade Daniel,Balan Daniel,Reman Tibor,Balan-Bernstein Noemi,Vida Arpad Oliver,Martha Orsolya. Validation of the importance of neutrophil-to-lymphocyte ratio in non-muscle invasive bladder cancer. Journal of Men's Health. 2021.doi:10.31083/jomh.2021.128.


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