# Preoperative Gamma-Glutamyltransferase-to-Lymphocyte Ratio as an Independent Prognostic Biomarker in Patients Undergoing Radical Cystectomy for Bladder Cancer

## TL;DR

This study shows that a blood test measuring gamma-glutamyltransferase and lymphocyte levels can predict survival outcomes in bladder cancer patients undergoing surgery.

## Contribution

The study identifies preoperative GLR as an independent prognostic biomarker for bladder cancer patients undergoing radical cystectomy.

## Key findings

- High GLR was significantly associated with worse overall, recurrence-free, and cancer-specific survival.
- GLR remained an independent predictor of survival outcomes even after adjusting for clinicopathological factors.
- The study suggests GLR could aid in risk stratification and postoperative management of bladder cancer patients.

## Abstract

Background and Objectives: Gamma-glutamyltransferase-to-lymphocyte ratio (GLR) is a prognostic biomarker reflecting oxidative stress and host immune status. However, its prognostic value in patients with bladder cancer undergoing radical cystectomy (RC) remains unclear. This study aimed to investigate whether preoperative GLR predicts survival outcomes following RC. Materials and Methods: We retrospectively reviewed 110 patients with urothelial carcinoma of the bladder (pure urothelial carcinoma or urothelial carcinoma with variant histology) who underwent RC at a single tertiary center between 2008 and 2022. GLR was calculated as serum gamma-glutamyltransferase (U/L) divided by absolute lymphocyte count (×109/L) using routine preoperative blood samples. Patients were categorized into low-GLR (≤17.0; n = 54) and high-GLR (>17.0; n = 56) groups based on the cohort median cut-off (17.0). Overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were assessed using Kaplan–Meier analysis and compared by log-rank tests. Cox proportional hazards models were used, including a preoperative model (Model 1) and a pathology-adjusted model incorporating postoperative variables (Model 2). Results: High GLR was associated with significantly worse OS, RFS, and CSS (log-rank: p = 0.020, p = 0.043, and p = 0.003, respectively). In multivariate analyses, high GLR was independently associated with inferior outcomes in both models. In Model 2, high GLR predicted worse OS (hazard ratio [HR] = 2.38; 95% confidence interval [CI] = 1.32–4.28; p = 0.003), RFS (HR = 2.37; 95% CI = 1.13–4.99; p = 0.020), and CSS (HR = 3.45; 95% CI = 1.56–8.52; p = 0.001). Conclusions: Preoperative GLR is a simple, inexpensive biomarker independently associated with survival after RC for bladder cancer, even after adjustment for established clinicopathological and pathological factors. GLR may support risk stratification and postoperative management, warranting prospective multicenter validation.