{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:22:01Z","timestamp":1785410521072,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009045","name":"Jagiellonian University Medical College","doi-asserted-by":"crossref","award":["N41\/DBS\/001437"],"award-info":[{"award-number":["N41\/DBS\/001437"]}],"id":[{"id":"10.13039\/100009045","id-type":"DOI","asserted-by":"crossref"}]},{"award":["N41\/DBS\/001437"],"award-info":[{"award-number":["N41\/DBS\/001437"]}],"id":[{"id":"https:\/\/ror.org\/03bqmcz70","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background. Accurate prediction of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in muscle-invasive urothelial bladder cancer (MIBC) remains an unmet clinical need. The neutrophil-to-platelet\/hemoglobin-to-lymphocyte (NPLH) ratio, a composite hematologic index that reflects both systemic inflammation and nutritional oxygen-carrying capacity, has not been previously evaluated as a predictor of NAC response in this setting. Methods. We retrospectively analyzed 114 consecutive patients with MIBC (cT2\u2013T4, N0\u2013N3) who received accelerated MVAC (aMVAC) NAC followed by radical cystectomy at a single academic center. Pretreatment NPLH (calculated as [neutrophils \u00d7 platelets]\/[hemoglobin \u00d7 lymphocytes]) was assessed as a predictor of pCR (ypT0N0) and tumor regression grade (TRG). Receiver operating characteristic (ROC) curve analysis, Mann\u2013Whitney U test, and logistic regression were used. NPLH performance was compared to NLR and PLR. Results. pCR was achieved in 35 patients (30.7%). Median NPLH was significantly lower in pCR vs. non-pCR patients (33.9 [IQR 23.1\u201342.4] vs. 47.6 [IQR 30.7\u201390.4]; p = 0.0007). NPLH yielded an AUC of 0.700 (bootstrap 95% CI 0.596\u20130.794) for pCR prediction, numerically superior to NLR (AUC 0.645 [0.542\u20130.741]) and PLR (AUC 0.643 [0.533\u20130.747]); DeLong test: NPLH vs. NLR p = 0.079, NPLH vs. PLR p = 0.090. At the optimal cut-off of 44.5, NPLH demonstrated 80.0% sensitivity and 57.0% specificity. pCR rates declined progressively across NPLH quartiles: 48.3% (Q1) to 10.3% (Q4). On multivariate logistic regression, log-transformed NPLH was the only independent predictor of pCR (parsimonious model, OR 0.292, 95% CI 0.131\u20130.652; p = 0.003; EPV = 17.5). A positive correlation was observed between NPLH and TRG score (Spearman r = 0.284; p = 0.0022), with significant differences between TRG 1 and TRG 3 subgroups (p = 0.0036). Conclusions. Pretreatment NPLH is an independent predictor of pCR to aMVAC in MIBC and is numerically superior to NLR and PLR (DeLong p = 0.079). Consisting exclusively of standard complete blood count parameters, NPLH is readily available and inexpensive. This single-center exploratory study is hypothesis-generating and requires prospective external validation before clinical implementation.<\/jats:p>","DOI":"10.3390\/cancers18132046","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:03:56Z","timestamp":1782349436000},"page":"2046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pretreatment NPLH as a Potential Predictor of Pathologic Complete Response to Accelerated MVAC Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer: Comparison with NLR and PLR"],"prefix":"10.3390","volume":"18","author":[{"given":"\u0141ukasz","family":"Kwinta","sequence":"first","affiliation":[{"name":"Oncology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland"},{"name":"Department of Oncology, University Hospital in Krakow, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil","family":"Konopka","sequence":"additional","affiliation":[{"name":"Oncology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland"},{"name":"Department of Oncology, University Hospital in Krakow, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1921-5007","authenticated-orcid":false,"given":"Krzysztof","family":"Oko\u0144","sequence":"additional","affiliation":[{"name":"Department of Pathomorphology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Krakow, Poland"},{"name":"Department of Pathomorphology, University Hospital in Krakow, 30-688 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"\u0141obacz","sequence":"additional","affiliation":[{"name":"Department of Oncology, University Hospital in Krakow, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Luba\u015b","sequence":"additional","affiliation":[{"name":"Department of Oncology, University Hospital in Krakow, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-7627","authenticated-orcid":false,"given":"Piotr","family":"Ch\u0142osta","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland"},{"name":"Clinical Department of Urology and Oncological Urology, University Hospital in Krakow, 30-688 Krakow, Poland"},{"name":"Department of Urology, Medical University of Vienna, University Hospital Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Dudek","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland"},{"name":"Clinical Department of Urology and Oncological Urology, University Hospital in Krakow, 30-688 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4003-5278","authenticated-orcid":false,"given":"Piotr J.","family":"Wysocki","sequence":"additional","affiliation":[{"name":"Oncology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland"},{"name":"Department of Oncology, University Hospital in Krakow, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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