C-reactive protein as a prognostic predictor for non-muscle invasive bladder cancer after intravesical bacillus Calmette-Guérin therapy: A Japan Urological Oncology Group study analysis.

To investigate the involvement of pretreatment C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients who underwent intravesical bacillus Calmette-Guérin (BCG) therapy for non-muscle invasive bladder cancer (NMIBC).

The clinicopathological data of 1709 patients with NMIBC who underwent initial intravesical BCG therapy after transurethral resection of bladder tumor were retrospectively analyzed to evaluate the outcome of intravesical BCG therapy in a multicenter study conducted by the Japan Urological Oncology Group. The prognoses of these patients were analyzed to determine whether the biomarkers (CRP and NLR) could predict the efficacy of intravesical BCG therapy. Patients were divided into two groups according to the pretreatment CRP and NLR, with cutoff values defined as CRP ≥ 0.5 mg/dl and NLR ≥ 2.5, based on several previous reports.

In the univariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence, cancer-specific survival, and bladder cancer (BC) progression, while NLR ≥ 2.5 was not significantly associated with patient prognosis. In the multivariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence and BC progression. The concordance index was used to examine the accuracy in predicting recurrence and progression events. While CRP was slightly, though not statistically significant, inferior to the European Association of Urology risk classification, the combination of them showed improved predictive accuracy.

This study suggests that CRP can be a prognostic factor after intravesical BCG therapy and may provide useful data for determining treatment and follow-up strategies for patients with NMIBC.

International journal of urology : official journal of the Japanese Urological Association. 2022 Nov 30 [Epub ahead of print]

Ryoma Nishikawa, Makito Miyake, Shuichi Morizane, Ryutaro Shimizu, Shogo Teraoka, Masashi Honda, Kota Iida, Nobutaka Nishimura, Tomokazu Sazuka, Takahiro Kimura, Akihiro Ito, Kenichiro Shiga, Rikiya Taoka, Takahiro Kojima, Takashi Kobayashi, Naotaka Nishiyama, Hiroshi Kitamura, Hiroyuki Nishiyama, Kiyohide Fujimoto, Atsushi Takenaka

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan., Department of Urology, Nara Medical University, Kashihara, Nara, Japan., Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Chiba City, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Minato-ku, Japan., Department of Urology, Tohoku University Graduates School of Medicine, Miyagi, Sendai, Japan., Department of Urology, Harasanshin Hospital, Fukuoka City, Fukuoka, Japan., Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan., Department of Urology, Aichi Cancer Center, Nagoya City, Aichi, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, Japan., Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan., Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.