Lymphocyte-to-Monocyte Ratio During BCG Induction Independently Predicts NMIBC Prognosis

The lymphocyte-to-monocyte ratio during bacillus Calmette-Guérin (BCG) induction therapy independently predicts the prognosis of patients with non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of a bladder tumor, according to a recent analysis.

The results of the retrospective analysis, led by Deng-xiong Li, Xiao-ming Wang and De-chao Feng, MD, of the West China Hospital at Sichuan University, were published in Frontiers in Oncology.

The study analyzed 197 patients with NMIBC who received BCG induction therapy after transurethral resection of a bladder tumor between 2014 to 2020 at a single center. Most patients were male (86%). The mean patient age was 64.17 years.

The preoperative lymphocyte-to-monocyte ratio was measured two weeks before surgery. The induction lymphocyte-to-monocyte ratio was measured during BCG induction. The dynamic change between the lymphocyte-to-monocyte ratio two weeks before surgery and during BCG induction was determined by dividing the preoperative lymphocyte-to-monocyte ratio by the induction lymphocyte-to-monocyte ratio.

Prognostic Value of Lymphocyte-to-Monocyte Ratios

Lower induction lymphocyte-to-monocyte ratios were associated with significantly higher recurrence rates (P=.002). Lower preoperative lymphocyte-to-monocyte ratios were also associated with significantly higher recurrence rates (P=.006).

The preoperative lymphocyte-to-monocyte ratio and the induction lymphocyte-to-monocyte ratio both independently predicted the recurrence of NMIBC (P=.011 and P<.001, respectively).

The induction lymphocyte-to-monocyte ratio and the dynamic change between the lymphocyte-to-monocyte ratio during BCG induction and two weeks before surgery were independent prognostic factors of NMIBC progression (P=.001 and P=.036, respectively).

The induction lymphocyte-to-monocyte ratio was associated with “better accuracy” and “higher prognostic value” than the preoperative lymphocyte-to-monocyte ratio and the dynamic change the preoperative and induction lymphocyte-to-monocyte ratios, according to the authors.

Clinical Implications

This data may help clinicians determine therapeutic options for patients with NMIBC, as “urologists are continually devoted to finding a readily available and powerful prognostic factor to screen out patients who have no response to BCG and should accept early aggressive treatment,” investigators wrote.

The prognostic value of the induction lymphocyte-to-monocyte ratio might allow patients and clinicians to “predict the outcome of BCG immunotherapy early and adjust the treatment plan in time,” the authors concluded.

Reference

Lymphocyte-to-monocyte ratio (LMR) during induction is a better predictor than preoperative LMR in patients receiving intravesical Bacillus Calmette-Guerin for non-muscle-invasive bladder cancer