Prognostic Significance of Pre-Treatment Serum Markers in Muscle-Invasive Bladder Cancer Under Tri-Modality Therapy

Objectives: Since limited data for prognosis prediction in bladder cancer treated by organ-preservation strategy, we aimed to assess the impact of lymphocyte ratios in conjunction with other blood cell parameters on treatment outcomes, and investigate whether dose escalation could ameliorate poor tumor control as defined by these markers. Method: We investigated the impact of pre-treatment neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte count (PLR) on tumor control and survival in 102 MIBC patients undergoing TMT. Cutoff values were determined using receiver operating characteristic curves, and outcomes assessed included locoregional control, progression-free survival, distant metastasis-free survival, and overall survival. Results: In univariate analysis, lower NLR values, higher LMR values, and lower PLR values were associated with improved prognosis. Multivariate analysis revealed that LMR was correlated with locoregional control (HR 0.368, 95% CI 0.202-0.673, p=0.001) and tumor progression (HR 0.292, 95% CI 0.170-0.501, p<0.001), while NLR was associated with distant control (HR 0.413, 95% CI 0.181-0.942, p=0.036) and survival (HR 0.238, 95% CI 0.121-0.471, p<0.001). Dose escalation in radiotherapy, when applied in patients with lower LMR values or higher NLR values, improved locoregional control and tumor progression in the lower LMR group but did not confer benefits in distant control or survival for the higher NLR group. Conclusion: This study underscores the impact of lymphocyte ratios, including LMR and NLR, on tumor control under TMT with higher lymphocyte ratio would have better tumor control. And escalated radiotherapy can enhance locoregional tumor control in patients with lower LMR values.