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

Wei Li; Chenhui Xiang; Guoping Xie; Yuanyuan Zhang

doi:10.2147/IJGM.S595401

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

Int J Gen Med. 2026 Apr 1:19:595401. doi: 10.2147/IJGM.S595401. eCollection 2026.

Authors

Wei Li^#¹, Chenhui Xiang^#¹, Guoping Xie¹, Yuanyuan Zhang²

Affiliations

¹ Department of Urology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.
² Department of Clinical Laboratory Medicine, Xindu District People's Hospital of Chengdu, Chengdu, Sichuan, People's Republic of China.

^# Contributed equally.

Abstract

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.