Role of inflammatory markers and frailty index as predictors of adverse pathological stage and complications in patients undergoing radical cystectomy for bladder cancer: a multicentre analysis

Background: Aim of our study was to assess patient frailty and inflammatory state as predictors of adverse pathological outcomes and complications after radical cystectomy for bladder cancer (BCa). Materials and Methods: We performed an analysis of prospectively collected data of consecutive patients undergoing radical cystectomy for bladder cancer in 10 primary care Italian urology centers from 1 st September 2021 to 1 st December 2023. Charlson comorbidity index (CCI) and Frailty index (FI) was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Inflammatory status was evaluated with neutrophil/lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), fibrinogen and albumin levels. Logistic regression analysis was used to evaluate the role of frailty index and inflammatory status as predictors of adverse pathological outcomes (pT≥3a) and complications (Clavien ≥II). Results: Two hundred and sixty-seven patients were enrolled with a median age of 70 (63/76) years old. Overall, 50/267 (19%) patients presented a sFI score≥3, 117/267 (44%) patients presented advanced disease (≥3a) and 114/267 (43%) patients presented complications. In binary logistic regression analysis, FI and CCI were predictors of adverse pathological outcomes and complications. Inflammatory markers were not predictors neither of advanced pathological stage neither complication. Conclusions: In patients undergoing radical cystectomy, FI and Charlson comorbidity index are not predictors of adverse pathological outcomes and complications. Further studies should assess the role of these markers in the management of these patients.