Association of preoperative hematological indices with high-grade pathology in non-muscle-invasive bladder cancer: A retrospective cross-sectional study

This study evaluated the associations and standalone discriminatory performance of preoperative hemoglobin-adjusted lymphocyte-to-neutrophil ratio (HLNR), lymphocyte-to-neutrophil ratio (LNR), hemoglobin-adjusted lymphocyte-to-platelet ratio (HLPR) for high-grade pathology in patients undergoing transurethral resection of bladder tumor (TURBT) for primary non-muscle-invasive bladder cancer. We further assessed whether LNR or HLNR provided incremental information beyond demographic and endoscopic variables available before histopathological assessment. We retrospectively analyzed 176 patients with primary non-muscle-invasive bladder cancer (NMIBC) (Ta–T1) who underwent TURBT between February 2016 and February 2025. The primary endpoint was high-grade tumor on the initial TURBT histopathological examination. Model A included age, sex, endoscopic tumor size, and tumor multiplicity; Model B added LNR and Model C added HLNR. Model fit, discrimination, internal validation, and calibration were assessed. Of 176 patients, 57 (32.4%) had high-grade tumors. LNR was associated with high-grade pathology in univariable analysis (Odds Ratio (OR) = 1.013, 95% confidence interval (CI) 1.002 – 1.025; p = 0.024). Model A had an Area Under Curve (AUC) of 0.762. After adjustment, LNR (Model B: OR = 1.012, p = 0.089) and HLNR (Model C: OR = 1.07, p = 0.140) were not independently associated with high-grade pathology, and neither significantly improved model fit or AUC. The hemoglobin × LNR interaction was nonsignificant (p = 0.389). After exclusion of 43 T1 low-grade tumors, LNR (p = 0.366) and HLNR (p = 0.521) remained nonsignificant. LNR was associated with high-grade pathology in univariable analysis, but this association was attenuated after adjustment for demographic and endoscopic tumor characteristics. Neither LNR nor HLNR significantly improved model fit or discrimination beyond the pre-pathology clinical model. These findings are exploratory and require validation in larger cohorts.