# Prognostic Significance of Hemogram Parameters in Non-Muscle Invasive Bladder Cancer: A Comprehensive Retrospective Analysis

## TL;DR

This study shows that blood count parameters, especially hemoglobin levels, can predict outcomes in bladder cancer patients and may improve treatment planning.

## Contribution

The study identifies hemoglobin as an independent prognostic marker for bladder cancer recurrence and suggests integrating it into risk stratification systems.

## Key findings

- Lower hemoglobin levels were independently associated with higher recurrence risk in bladder cancer patients.
- Hemoglobin had the highest predictive accuracy (AUC 0.692) for recurrence among blood parameters.
- Incorporating hemoglobin into risk models could improve personalized treatment strategies for non-muscle invasive bladder cancer.

## Abstract

Background and Objectives: To evaluate the prognostic significance of preoperative complete blood count parameters in patients with non–muscle-invasive bladder cancer (NMIBC), to determine optimal cutoff values, and to explore their potential integration into existing risk stratification systems. Materials and Methods: In this retrospective cohort study, 551 patients with NMIBC treated between January 2007 and December 2024 were analyzed. Complete blood count parameters obtained within 30 days prior to transurethral resection were collected. The primary endpoints were disease recurrence and progression. Statistical analyses included the Mann–Whitney U test, Kaplan–Meier survival analysis, Cox proportional hazards regression, and receiver operating characteristic (ROC) curve analysis. Results: Complete data were available for 548 patients (mean age 66.3 ± 11.3 years, 70.3% male). Disease recurrence occurred in 203 patients (37.0%) and progression in 60 patients (10.9%). Compared with the non-recurrence group, patients with recurrence had lower hemoglobin (11.8 ± 2.3 vs. 13.2 ± 2.4 g/dL, p < 0.001), higher lymphocyte counts (2.4 ± 3.3 vs. 2.1 ± 2.9 ×103/µL, p = 0.025), and lower neutrophil counts (5.3 ± 3.0 vs. 6.1 ± 3.4 × 103/µL, p < 0.001). In multivariable analysis, hemoglobin (HR 0.75, 95% CI 0.68–0.83, p < 0.001), age (HR 1.02, 95% CI 1.00–1.03, p = 0.023), and carcinoma in situ (HR 1.69, 95% CI 1.13–2.53, p = 0.011) were independent predictors of recurrence. Hemoglobin yielded the highest AUC for predicting recurrence (0.692). Conclusions: Routinely available hematologic indices—particularly hemoglobin concentration—exhibit independent prognostic value in patients with NMIBC. Incorporating these parameters into established risk stratification models may enhance personalized treatment strategies.