Platelet-to-lymphocyte ratio as a useful biomarker of recurrence and mortality risks in patients with muscle-invasive bladder cancer who achieved ypT0 to neoadjuvant chemotherapy: A multicenter retrospective study.

873 Background: Platelet-to-lymphocyte ratio (PLR), a novel inflammatory marker, has been suggested to predict recurrence and mortality in several malignancies. Patients with muscle-invasive bladder cancer (MIBC) who achieved a pathological complete response (ypT0) to neoadjuvant chemotherapy (NAC) have a favorable prognosis. However, the risk factors for recurrence and mortality remain unclear. Methods: This multi-institutional retrospective study assessed 950 patients with MIBC who underwent radical cystectomy (RC). Of the 950 patients, 128 patients who achieved a pathological complete response (ypT0) to 2–4 cycles of NAC were included. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify the risk factors for recurrence and mortality. Results: The median age and follow-up period were 69 years and 80 months, respectively. Of the 128 patients, 15 (12%) and 30 (23%) experienced recurrence and died from any cause, respectively. The most frequent recurrence site was lymph nodes (n = 11, 73%), followed by urothelium (n = 4, 27%). The 10-year recurrence-free survival (RFS) and 10-year overall survival (OS) rates were 85.9% and 73.1%, respectively. In the univariable and multivariable analyses, clinical lymph node involvement, neobladder reconstruction, and PLR were independently and significantly associated with RFS (Table). In the univariable and multivariable analyses, age and PLR were independently and significantly associated with OS. Conclusions: Recurrence was not a rare event in patients with MIBC who achieved ypT0. PLR may be a useful biomarker to assess recurrence and mortality risks. Multivariable analysis for RFS. Factor P value Hazard ratio 95% CI Clinical lymph node involvement Positive 0.021 3.732 1.219–11.42 Urinary diversion Neobladder 0.281 0.281 0.094–0.842 PLR Continuous 0.029 1.003 1.000–1.006