Postoperative Neutrophil-to-Albumin Ratio as a Prognostic Marker for Patients with Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Observational Cohort Study

Objective: This study aimed to investigate the prognostic value of the postoperative neutrophil-to-albumin ratio (NAR) in patients with bladder cancer undergoing radical cystectomy. Patients and Methods: A total of 368 patients with histologically confirmed bladder cancer who underwent radical cystectomy between January 2018 and December 2021 were retrospectively analyzed. Postoperative NAR was calculated using neutrophil count (%) and serum albumin concentration (g/L) measured approximately three months after surgery. Receiver operating characteristic analysis identified the optimal NAR cutoff value for predicting 5-year overall survival. Kaplan–Meier and Cox regression models were used to assess associations between NAR and overall survival or recurrence-free survival. Results: The optimal NAR cutoff value was 2.6 with an AUC value of 0.76. Elevated NAR was significantly correlated with bladder cancer of invasive pathological types (p = 0.005), advanced tumor stage (p < 0.0001), lymph-node metastasis (p = 0.002), and receipt of neoadjuvant chemotherapy (p = 0.014). Patients with elevated NAR had significantly shorter overall survival (HR=3.14; 95% CI, 1.27– 6.24; p = 0.002) and recurrence-free survival (HR=3.27; 95% CI, 1.52– 5.87; p = 0.001) compared with those with low NAR. In multivariate analysis, postoperative NAR (p = 0.001), tumor stage (p = 0.002), and pathological type (p = 0.013) were independent predictors of overall survival, while NAR (p = 0.002), tumor stage (p = 0.003), and lymph-node metastasis (p = 0.014) independently predicted recurrence-free survival. Conclusion: An increased postoperative NAR independently predicts poorer overall and recurrence-free survival of bladder cancer patients following radical cystectomy. As an inexpensive and readily available biomarker reflecting systemic inflammation and nutritional status, NAR may serve as a practical tool for postoperative risk stratification and individualized patient management. Keywords: bladder cancer, neutrophil-to-albumin ratio, radical cystectomy, systemic inflammation