Neutrophils to lymphocytes ratio as a predictor of BCG response in non-muscle invasive bladder cancer.

Aim: To evaluate the role of preoperative neutrophils to lymphocytes ratio (NLR) as a predictor for the response to BCG in patients with non-muscle invasive bladder cancer (NMIBC).

Materials: Nighty six patients with NMIBC were prospectively included in our study. Our study population was classified into two groups, based on pre-operative (NLR) either ⩽ or > 3. After receiving BCG, patients were followed up for 3 years to evaluate the correlation between BCG failure and (NLR).

Results: Nighty two patients were evaluated at the end of our study. The NLR > 3 group of patients showed a higher age and T stage compared to the NLR ⩽ 3 group with a significant difference. BCG failure was reported to be higher in the NLR > 3 group with a failure rate of 66.7% compared to 28.3% in the other group (p-value < 0.001). Time to failure in NLR > 3 group compared to NLR ⩽ 3 group was 10.44 ± 4.3 and 15 ± 3.9 months respectively with a (p-value = 0.002). Univariate and multivariate logistic regression revealed that the most significant predictors of BCG failure were NLR > 3, Initial T stage, and age respectively.

Conclusion: BCG response is highly affected by the NLR, with a higher failure rate with NLR > 3.