Prediction of recurrence using hematologic and urinary markers in intravesical Bacillus calmette Guerin treated bladder cancer

Abstract

Abstract Intravesical bacillus Calmette-Guérin (BCG) therapy reduces recurrence in non-muscle invasive bladder cancer (NMIBC). Various scoring models have been developed to predict recurrence, and this study aims to improve them by analyzing hematologic parameters and urinary immune cells. This study involved 88 bladder cancer patients treated with BCG between January 2022 and January 2023. Preoperative hematological parameters were recorded from two separate blood samples. Urine samples were collected before and after the first and sixth BCG instillations and analyzed by flow cytometry to determine the proportions of T cells, neutrophils, and myeloid-derived suppressor cells (MDSCs). Results were compared based on recurrence status and within-group changes. Six patients died from non-cancer causes, and five were excluded due to irregular follow-ups or external monitoring. Of the remaining 77 patients, followed for an average of 30 months, 12 experienced recurrence, and 65 did not. No significant differences were found in clinical or histopathological factors. Urine analysis revealed a higher Neutrophil/T cell ratio in patients with recurrence, while the T/MDSCs ratio increased significantly in the non-recurrent group post-BCG. Additionally, the MDSCs/Total Cell ratio significantly decreased post-treatment in the non-recurrent group. Peripheral blood analysis showed no significant differences in Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR). The results suggest a T cell-dominant immune response may prevent recurrence, while an MDSCs-dominant environment increases the risk. Changes in urinary T/MDSCs, MDSCs/Total Cell, and Neutrophil/T cell ratios may serve as potential biomarkers for predicting recurrence risk shortly after induction therapy.