Mean platelet volume to lymphocyte ratio as an inflammatory marker associated with high-grade recurrence and progression of non-muscle-invasive bladder cancer treated with Bacillus Calmette-Guérin.

To assess the value of a novel inflammatory marker involving the ratio between mean platelet volume and lymphocyte counts (MPVL) in the prediction of high-grade recurrence-free survival (HG RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC) treated with adjuvant Bacillus Calmette-Guérin (BCG) therapy. In this retrospective, single tertiary centre study the medical records of 216 consecutive patients with NMIBC, who received BCG between 2010 and 2019, were reviewed. Kaplan-Meier curves and Cox proportional hazard regression were used for survival analysis. We included 194 patients who underwent transurethral resection of a bladder tumour and received at least an induction course of BCG. The majority of patients presented with high-grade T1 tumours (n = 114, 59%). Within a median follow-up of 65 months (IQR: 27-93), 35 patients (18%) experienced progression, and 69 (34.5%) had a high-grade recurrence. Kaplan-Meier analyses revealed a significant association between higher MPVL and worse PFS and HG RFS (both p <0.05). Specifically, patients with higher MPVL demonstrated decreased 5-year PFS (75% vs 90%) and HG RFS (54.5% vs 75%) compared to lower MPVL counterparts. Multivariate analyses confirmed the independent prognostic value of MPVL for HG RFS (HR = 1.7, p = 0.047) and PFS (HR = 2.37, p = 0.026). In patients with NMIBC treated with adjuvant BCG, an elevated inflammatory marker comprising mean platelet volume and lymphocyte count ratio may serve as a prognostic factor associated with worse PFS and HG RFS. The role of MPVL in clinical decision-making must be validated in further multicentre prospective studies.