title: Preoperative neutrophil-lymphocyte ratio and fibrinogen level in patients distinguish between muscle-invasive bladder cancer and non-muscle-invasive bladder cancer.
abstract: BACKGROUND
  The aim of this study was to explore if the preoperative neutrophil-lymphocyte ratio (NLR) and fibrinogen level can help in distinguishing between muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  We identified 669 patients who underwent surgery at our institution, and evaluated their preoperative NLRs and fibrinogen levels. Patients were divided into two groups, NMIBC (group-I) and MIBC (group-II), according to the postoperative pathology. For the intergroup comparison, data obtained from the two groups were evaluated using independent samples t-test. The cutoff value of the NLR, fibrinogen level, and integrated NLR and fibrinogen level was determined with receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The mean NLRs of group-I and group-II were found as 2.71±2.46 and 4.66±8.00, respectively (P<0.001). The fibrinogen levels of the two groups were ~3.13±0.70 g/L and 3.41±0.84 g/L, respectively (P=0.001). Whether the NLR, fibrinogen level, and integrated NLR and fibrinogen level can help in distinguishing between MIBC and NMIBC was evaluated with ROC curve. The cutoff value of NLR was estimated as 2.01 according to the Youden index. With this value, sensitivity was found as 67.1%, specificity was 52.7%, and area under receiver operating characteristic (ROC) curve (AUC) was 0.601 (P=0.031). The cutoff value of fibrinogen level was estimated as 3.17 g/L according to the Youden index. Accordingly, sensitivity was found as 58%, specificity was 58%, and AUC was 0.60 (P=0.001). The cutoff value of integrated NLR and fibrinogen level was found as 0.166; the sensitivity was found as 86%, specificity was 42%, and AUC was 0.801 (P=0.01).
  
  
  CONCLUSIONS
  The data obtained in this study suggested that 67.1% of Ta-T1 tumors were likely to be invasive if the NLR was >2.01 and 58% were likely to be invasive if the fibrinogen level was >3.17 g/L. When we used both the NLR and fibrinogen level to distinguish between the MIBC and NMIBC, sensitivity was found to be 86%, and specificity was 42%.
authors.affiliation: Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Chengquan
authors.initials: C
authors.lastname: Ma
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Bingxin
authors.initials: B
authors.lastname: Lu
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Chengwen
authors.initials: C
authors.lastname: Diao
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Zhao
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Xinpeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Baojing
authors.initials: B
authors.lastname: Ma
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Baojian
authors.initials: B
authors.lastname: Lu
authors.affiliation: Tianjin Key Lab of Urology Basic Science, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
authors.forename: Erlin
authors.initials: E
authors.lastname: Sun
keywords: MIBC; NLR; NMIBC; ROC; fibrinogen