Risk stratification for bladder cancer: Biomarkers of inflammation and immune activation

Abstract

Objective: Recent development is reviewed in biomarkers of inflammation and immune activation in risk stratification of bladder cancer (BC).

Methods: PubMed, Wiley Online Library, and Science Direct databases were reviewed in November 2019 for relevant studies limited to those published in English from 2008 to 2019. Articles were included if they contained references to BC, urological cancers, inflammation, immune activation, disease risk, disease progression, genomics, proteomics, and biomarkers.

Results: Inflammatory biomarkers show promise in prognostication in BC, including neutrophil-to-lymphocyte ratio, C-reactive protein, selected cytokines and stress proteins. Most of the current evidence, however, stems from retrospective studies. None of these biomarkers are sufficient by themselves to be used for prognostication. Using a panel of different biomarkers, alongside clinical and pathological data, seems to improve risk stratification. More robust data is necessary, however, before these biomarkers will be suitable for use in routine practice.

Conclusion: Biomarkers of inflammation and immune system activation can assist in risk stratification of BC. Currently most of these biomarkers lack robust external validity. In the future these biomarkers likely will have an important role in augmenting the conventional clinical and pathological predictors of outcomes in BC.

Keywords: Bladder cancer; Bladder malignancy; Cystectomy; Immune response; Immunology; Inflammation; Nomograms; Prognosis; Progression; Recurrence; Risk stratification; Scoring system.