Novel Hematologic Markers for Risk Stratification in Bladder Cancer Patients Receiving BCG Treatment

Objective: In order to evaluate the predictive role of novel hematologic markers in recurrence and progression among non-muscle invasive bladder cancer (NMIBC) patients undergoing intravesical BCG therapy.Material and Methods: A total of 182 patients diagnosed with NMIBC and treated with transurethral resection of bladder tumor (TUR-BT) followed by BCG therapy were included. Patients were stratified into intermediate-, high- and very high-risk groups per the EAU 2024 guidelines. Preoperative hematologic parameters were recorded. In addition, CLR, CAR, and IBI were calculated. Recurrence and progression were assessed through follow-up cystoscopies. ROC curve analysis was used to determine the predictive value of the biomarkers.Results: Recurrence and progression occurred in 15% and 8% of patients, respectively. Multifocal tumors showed a notable association with recurrence (p = 0.006), and carcinoma in situ (CIS) predicted progression (p < 0.001). CAR (AUC = 0.695, p = 0.013) and CLR (AUC = 0.660, p = 0.040) significantly predicted progression. IBI was a strong predictor in the very high-risk group (AUC = 0.920, p < 0.001).Conclusion: CLR, CAR, and IBI are promising markers for identifying patients at higher risk of progression during BCG therapy. IBI shows strong prognostic utility in very high-risk NMIBC patients. Further prospective, multicenter studies are needed for clinical validation.