AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.2025.0012
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RESEARCH ARTICLE

Diagnostic value of preoperative computed tomography-urography combined with inflammatory markers in predicting lymph node metastasis in patients undergoing radical cystectomy

Kun Yang1,2 ,  Mingxin Jiang1,2 ,  Tianyu Zhang1,2 ,  Yunpeng Fan1,2 ,  Yongde Xu1,2 ,  Lei Wang1,2 ,  Xi Zhu1,2 ,  Zhengguo Ji1,2 ,  Wei Qiu1,2 ,  Lang Feng1,2 ,  Jun Li1,2 ,  Daoxin Zhang1,2 ,  Gangyue Hao1,2 ,  Yinong Niu1,2*
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1 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
2 Institute of Urology, Beijing Municipal Health Commission, Beijing 100050, China
Bladder, e21200055 https://doi.org/10.14440/bladder.2025.0012
Submitted: 24 February 2025 | Revised: 20 May 2025 | Accepted: 22 May 2025 | Published: 7 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Lymph node metastasis represents a critical prognostic factor in bladder cancer and significantly influences treatment choice and outcomes. Objective: To evaluate the predictive value of the maximum short-axis diameter of pelvic lymph nodes on preoperative computed tomography-urography (CTU), in combination with inflammatory markers, in the prediction of lymph node metastasis in radical cystectomy (RC) patients. Methods: A retrospective analysis was conducted on 210 patients who had received CTU within one month before RC at Beijing Friendship Hospital from January 2016 to December 2023. Upon screening, 174 patients were included and assigned into two groups based on postoperative pathology: i.e., lymph node metastasis group (n = 43) and non-metastasis group (n = 131). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. The maximum short-axis diameter of a lymph node ≥8 mm was considered indicative of metastasis. Receiver operating characteristic (ROC) curve analysis was performed to assess predictive performance, determine optimal cutoffs, and construct a prediction model using multivariate logistic regression. Results: Significant differences (P < 0.05) were observed between groups in clinical T stage, tumor grade, NLR, PLR, MLR, and CTU lymph node diameter. ROC analysis revealed optimal cutoff values for NLR (3.22), PLR (156.4), and MLR (0.62). Multivariate logistic regression identified clinical T stage, CTU lymph node diameter, MLR, and PLR as independent predictors (P < 0.05). The resulting model achieved an area under the curve of 0.847 (95% confidence interval: 0.777 – 0.917). Conclusion: A nomogram incorporating CTU findings, clinical T stage, MLR, and PLR effectively predicts lymph node metastasis in RC patients. However, further multi-center validation is required before clinical implementation.

Keywords
Bladder cancer
Pelvic lymph node metastasis
Computed tomography-urography
Inflammatory markers
Funding
This study was supported by the Beijing Key Clinical Specialty Project (20240930).
Conflict of interest
The authors declare that they have no competing interests.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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