LAR, FAR, and PLR as Prognostic Factors in High-Grade Urothelial Carcinoma of the Bladder After Surgery

Huadong Xie ¹ 元必 黄 ² Chengjie Ban ³ Wei Wei ³ Han Tang ³ Qingming Huang ³ Zhengwei Su ³ Zhi Cheng ¹ Tianling Liao ⁴ Kangji Liao ⁵ Liquan Zhou ^1* Xinlin Yi ^1*

• ¹ Second Affiliated Hospital of Guangxi Medical University, Nanning, China
• ² Liuzhou Workers Hospital, Liuzhou, Guangxi Zhuang Region, China
• ³ Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Region, China
• ⁴ Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
• ⁵ Wuming Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi Zhuang Region, China

Objective: We evaluated the prognostic significance of the Lactate Dehydrogenase-to-Serum Albumin Ratio (LAR), Fibrinogen-to-Albumin Ratio (FAR), and Platelet-to-Lymphocyte Ratio (PLR) in patients with high-grade urothelial carcinoma (HGUC) of the bladder who underwent radical cystectomy (RC). These markers have been reported to be associated with the prognosis of various cancers.Methods: A retrospective analysis was conducted on HGUC patients who underwent RC at Guangxi Medical University Cancer Hospital between January 2013 and June 2021. Optimal cutoff values for LAR, FAR, and PLR were established. Kaplan-Meier survival analysis was used to evaluate survival outcomes, while univariate and multivariable Cox regression analyses identified independent prognostic factors. A nomogram was developed to predict survival, with validation through time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).Results: A total of 180 patients were included, with a follow-up period ranging from 2 to 127 months (49.28 ± 37.87 months). The optimal cutoff values for LAR, PLR, and FAR were 4.46, 139.68, and 0.13, respectively. Multivariable Cox regression identified tumor stage, LAR, PLR, and FAR as independent prognostic factors. Specifically, Stage III (HR = 25.44, 95% CI: 5.20–124.35, p < 0.001) and Stage IV (HR = 11.28, 95% CI: 3.18–40.05, p < 0.001) were independent risk factors for poor survival. A low PLR (HR = 0.45, 95% CI: 0.27–0.76, p = 0.003), low FAR (HR = 0.51, 95% CI: 0.29–0.89, p = 0.018), and low LAR (HR = 0.39, 95% CI: 0.23–0.67, p < 0.001) were independently associated with improved survival. The nomogram demonstrated high accuracy in predicting 1-, 3-, and 5-year overall survival (OS), with area under the curve (AUC) values of 0.866, 0.84, and 0.831, respectively. Further validation confirmed the model's stability and clinical applicability.Conclusion: LAR, PLR, and FAR are promising prognostic factors for HGUC of the bladder following RC, showing substantial potential for prognostic evaluation.