Nordic Cystectomy Study I - Neutrophil-lymphocyte Ratio (NLR)
Nordic Cystectomy Study I - Neutrophil-lymphocyte Ratio (NLR)
Around 7200 cases of Muscle Invasive Bladder Cancer are diagnosed annually in the Nordic
 countries combined. Muscle Invasive Bladder Cancer is an aggressive disease and it is linked
 with high mortality rates. The golden standard of treatment is radical cystectomy (RC) (the
 surgical removal of the bladder) and radical removal of lymph nodes in the pelvis. In
 addition to surgical treatment, and especially in cases where the tumour invades tissues
 surrounding the bladder or lymph nodes, chemotherapy is recommended. Chemotherapy can be
 administered before or after surgery, in a neoadjuvant (NAC) or adjuvant setting (AC).
 Although most patients recover well from surgery, there are significant risks regarding
 radical cystectomy. The greatest challenges in planning the treatment are making individual
 risk assessments and prognosis for the treated patients. Neoadjuvant chemotherapy is also
 insufficiently used and it is hard to predict how the tumour responds to chemotherapy.

 The purpose of this study is to collect prospective clinical data on radical cystectomy
 -patients in co-operation with other Nordic countries: Sweden, Denmark, Iceland and Norway.
 The collected data is used to validate existing prediction tools and discover novel tools for
 prediction of morbidity related to RC and prediction of oncological outcome after RC. The
 study is divided into three sub-studies. The second sub-study is on the preoperative
 neutrophil-lymphocyte ratio (NLR). Some studies suggest that NLR might be a predictor of
 oncological outcome of BC after RC. In addition, NLR has been suggested to correlate with NAC
 response and outcome after NAC and RC. The used cut-off value for NLR has varied between
 2.26-3.0.

 Patients will be allocated into two groups: low NLR ratio (NLR<3), and high NLR ratio
 (NLR≥3). The lab test will be retrieved before RC at the time of routine clinical laboratory
 testing for all patients and also before the initiation of NAC for patients planned to have
 chemotherapy. The primary end-point is bladder-cancer specific survival and, and secondary
 endpoints include progression-free, and overall survival.
Inclusion Criteria:

 1. Histologically confirmed urinary BC planned to be treated with RC with or without
 neoadjuvant chemotherapy.

 2. Histologically confirmed urinary BC planned to be treated with palliative cystectomy
 2) Signed informed consent 3) Patient age >18 years

 Exclusion Criteria:

 1. RC for other reasons than BC

 2. Other forms of surgical treatment of BC than RC (e.g. bladder resection).

 3. Patient unwillingness to participate in the study for any reason (i.e. lack of signed
 consent).