# A nomogram based on the red cell distribution width to lymphocyte ratio as a prognostic tool for non-muscle-invasive bladder cancer: a retrospective study

## TL;DR

This study shows that a blood test-based ratio (RLR) can predict bladder cancer recurrence and survival after surgery, outperforming other similar ratios.

## Contribution

A novel nomogram using RLR improves recurrence prediction for non-muscle-invasive bladder cancer patients.

## Key findings

- High preoperative RLR is an independent predictor of worse recurrence-free and overall survival.
- RLR outperformed PLR and NLR in predicting recurrence at 1 and 3 years.
- The RLR-based nomogram showed better accuracy and potential clinical benefit than traditional models.

## Abstract

This study investigated the prognostic value of the preoperative red cell distribution width to lymphocyte ratio (RLR) for recurrence-free survival (RFS) and overall survival (OS) in patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumor (TURBT).

A retrospective analysis was performed on data from 239 patients who received TURBT. The optimal RLR cutoff was determined using time-dependent receiver operating characteristic (ROC) curve analysis. Survival outcomes were assessed using Kaplan-Meier curves and univariate/multivariate Cox regression. An RFS prognostic nomogram incorporating independent factors was developed and evaluated via the concordance index (C-index), calibration plots, time-dependent ROC, and decision curve analysis (DCA). Subgroup analyses assessed the consistency of the RLR-RFS association.

Results: Elevated preoperative RLR was an independent prognostic factor for worse RFS and OS. Moreover, compared to the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), RLR demonstrated relatively higher predictive performance for 1-year and 3-year RFS. The novel nomogram incorporating the RLR parameter demonstrated improved predictive accuracy and a trend toward greater net clinical benefit compared to the conventional model based solely on the EORTC recurrence risk classification. Subgroup analysis indicated a stronger relationship between high RLR and poor RFS in patients with pTaN0M0 compared to those with pT1N0M0.

Preoperative RLR represents a potential independent prognostic indicator for tumor recurrence in NMIBC patients following TURBT. The RLR-based nomogram may improve recurrence risk prediction in this population.