{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:06:05Z","timestamp":1779879965106,"version":"3.53.1"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard of care for eligible patients with locally advanced bladder cancer (LABC). However, adjuvant chemotherapy (AC) remains widely used in real-world practice. Host-related inflammatory and nutritional biomarkers may also influence survival outcomes. This study aimed to compare survival outcomes between NAC and AC and to identify independent prognostic factors for overall survival (OS) and progression-free survival (PFS), with particular emphasis on the Prognostic Nutritional Index (PNI). Methods: This multicenter retrospective study included 262 patients with locally advanced bladder cancer. The median age was 66 years, and 84% of patients were male. Patients were treated with neoadjuvant chemotherapy followed by radical cystectomy or adjuvant chemotherapy after surgery between August 2021 and March 2025. The Prognostic Nutritional Index (PNI) was calculated using pretreatment laboratory values. ROC analysis was used to determine the optimal PNI cut-off for predicting mortality, and the derived threshold (49.97) was applied for stratification in all survival analyses. Survival outcomes were evaluated using the Kaplan\u2013Meier method and compared using the log-rank test. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors. Results: Among 262 patients, 138 (52.7%) received NAC, and 124 (47.3%) received AC. Median follow-up was 33.6 months (95% CI: 29.4\u201337.8). No statistically significant differences in OS (p = 0.388) or PFS (p = 0.499) were observed between treatment groups. In univariate analyses, nodal stage, pathological complete response (pCR), and PNI were significantly associated with both OS and PFS. In multivariate analysis, low PNI (\u226449.97) remained an independent predictor of mortality (HR 1.78, 95% CI 1.04\u20133.38; p = 0.044), while N3 nodal stage independently predicted disease progression (HR 5.92, 95% CI 1.06\u201332.84; p = 0.042). Conclusions: In this multicenter real-world cohort, nodal stage and systemic inflammatory-nutritional status were key determinants of prognosis in patients with locally advanced bladder cancer receiving perioperative chemotherapy. PNI emerged as an independent predictor of overall survival, suggesting that host-related biomarkers may improve prognostic stratification beyond traditional clinicopathological factors.<\/jats:p>","DOI":"10.3390\/medicina62050992","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:19:52Z","timestamp":1779877192000},"page":"992","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the Prognostic Nutritional Index in Patients with Locally Advanced Bladder Cancer Receiving Perioperative Chemotherapy: A Multicenter Real-World Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4919-266X","authenticated-orcid":false,"given":"An\u0131l","family":"Karakayal\u0131","sequence":"first","affiliation":[{"name":"Department of Medical Oncology Clinic, Faculty of Medicine, Kocaeli City Hospital, \u0130zmit 41060, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4841-7994","authenticated-orcid":false,"given":"Mustafa","family":"Seyyar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Gaziantep City Hospital, Gaziantep 27470, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pervin Can","family":"\u015eanc\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, \u0130zmir \u00c7i\u011fli Training and Research Hospital, \u0130zmir 35620, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1976-3951","authenticated-orcid":false,"given":"Elif","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Clinic, Faculty of Medicine, Kocaeli City Hospital, \u0130zmit 41060, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5357-7610","authenticated-orcid":false,"given":"Berkan","family":"Karabu\u011fa","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara 06200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0182-3933","authenticated-orcid":false,"given":"\u00d6zt\u00fcrk","family":"Ate\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara 06200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"Bacak","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Afyonkarahisar Health Sciences University, Kocaeli 03030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3291-8134","authenticated-orcid":false,"given":"Meltem","family":"Baykara","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Afyonkarahisar Health Sciences University, Kocaeli 03030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0572-4927","authenticated-orcid":false,"given":"G\u00f6rkem","family":"Turhan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Karadeniz Technical University Farabi Hospital, Trabzon 61080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7082-2542","authenticated-orcid":false,"given":"Hikmet","family":"Akar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Manisa Celal Bayar University Hospital, Manisa 45030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-942X","authenticated-orcid":false,"given":"Ferhat","family":"Ekinci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Manisa Celal Bayar University Hospital, Manisa 45030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melek Karakurt","family":"Ery\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya 42080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0130-7111","authenticated-orcid":false,"given":"Berkay","family":"Ye\u015filyurt","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara 06800, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-211X","authenticated-orcid":false,"given":"Sinem","family":"Akba\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ko\u00e7 University Hospital, \u0130stanbul 34010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0937-0468","authenticated-orcid":false,"given":"Ali","family":"Kalem","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1041-9628","authenticated-orcid":false,"given":"Mesut","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Sakarya Training and Research Hospital, 54100 Sakarya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4055-9402","authenticated-orcid":false,"given":"Ece","family":"Demirdelen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne 22130, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semra","family":"Ta\u015f","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli 20070, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4057-3108","authenticated-orcid":false,"given":"O\u011fuzhan","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya 42080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0598-7284","authenticated-orcid":false,"given":"\u00d6zg\u00fcr","family":"Tanr\u0131verdi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University, Mu\u011fla 48000, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7312-3827","authenticated-orcid":false,"given":"Nadiye","family":"Sever","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Haydarpa\u015fa Numune Training and Research Hospital, \u0130stanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devrim","family":"\u00c7abuk","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli 41001, 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Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"330","DOI":"10.21037\/tau-23-79","article-title":"Neoadjuvant and adjuvant chemotherapy share equivalent efficacy in improving overall survival and cancer-specific survival among muscle-invasive bladder cancer patients who undergo radical cystectomy: A retrospective cohort study based on the SEER database","volume":"12","author":"Tan","year":"2023","journal-title":"Transl. Androl. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Advanced Bladder Cancer Meta-analysis Collaboration (2003). Neoadjuvant chemotherapy in invasive bladder cancer: A systematic review and meta-analysis. Lancet, 361, 1927\u20131934.","DOI":"10.1016\/S0140-6736(03)13580-5"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1056\/NEJMoa022148","article-title":"Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer","volume":"349","author":"Grossman","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1056\/NEJMoa2408154","article-title":"Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer","volume":"391","author":"Powles","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1470-2045(14)71160-X","article-title":"Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3\u2013pT4 or N+M0 urothelial carcinoma of the bladder (EORTC 30994)","volume":"16","author":"Sternberg","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_7","unstructured":"Advanced Bladder Cancer (ABC) Meta-analysis Collaborators Group (2022). Adjuvant chemotherapy for muscle-invasive bladder cancer: A systematic review and meta-analysis of individual participant data from randomized controlled trials. Eur. Urol., 81, 50\u201361."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3135","DOI":"10.1007\/s00432-022-03926-1","article-title":"Neoadjuvant versus adjuvant chemotherapy in bladder cancer: A nationwide cohort study","volume":"148","author":"Choi","year":"2022","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.eururo.2013.06.049","article-title":"Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: A meta-analysis","volume":"65","author":"Petrelli","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.eururo.2011.12.010","article-title":"Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer","volume":"61","author":"Rosenblatt","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1200\/JCO.2001.19.3.666","article-title":"Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1054 patients","volume":"19","author":"Stein","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1016\/j.juro.2006.08.004","article-title":"Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: A contemporary series from the bladder cancer research consortium","volume":"176","author":"Shariat","year":"2006","journal-title":"J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","article-title":"Hallmarks of cancer: The next generation","volume":"144","author":"Hanahan","year":"2011","journal-title":"Cell"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature07205","article-title":"Cancer-related inflammation","volume":"454","author":"Mantovani","year":"2008","journal-title":"Nature"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"dju124","DOI":"10.1093\/jnci\/dju124","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis","volume":"106","author":"Templeton","year":"2014","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jiang, H., Li, X., Cao, Y., Li, Y., Chen, J., Wu, Y., Feng, H., Zhu, J., Chen, Z., and Xu, G. (2017). Preoperative prognostic nutritional index is a significant predictor of survival with bladder cancer after radical cystectomy: A retrospective study. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3372-8"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1159\/000531884","article-title":"Prognostic ability of nutritional indices for outcomes of bladder cancer: A systematic review and meta-analysis","volume":"107","author":"Jiao","year":"2023","journal-title":"Urol. Int."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Necchi, A., Lo Vullo, S., Mariani, L., and RISC Investigators (2018). Neoadjuvant versus adjuvant chemotherapy in muscle-invasive bladder cancer: An exploratory analysis from the RISC database. Front. Oncol., 8.","DOI":"10.3389\/fonc.2018.00463"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12301-023-00398-8","article-title":"Comparison of responses to neoadjuvant and adjuvant chemotherapies in muscle-invasive bladder cancer","volume":"29","author":"Sekmek","year":"2023","journal-title":"Afr. J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Proietti, F., Flammia, R.S., Licari, L.C., Bologna, E., Bove, A.M., Brassetti, A., Tuderti, G., Mastroianni, R., Tufano, A., and Simone, G. (2024). Impacts of Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients with Bladder Cancer Treated with Radical Cystectomy: A Single High-Volume Center Experience. J. Pers. Med., 14.","DOI":"10.3390\/jpm14020212"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1038\/s41598-024-51273-7","article-title":"Pathological complete response to neoadjuvant chemotherapy may improve antitumor immune response via reduction of regulatory T cells in muscle-invasive bladder cancer","volume":"14","author":"Ikarashi","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00345-022-04187-w","article-title":"Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3\/4 or cN+ bladder cancer","volume":"41","author":"Wagner","year":"2023","journal-title":"World J. Urol."},{"key":"ref_23","unstructured":"Li, B., Deng, H., Lei, B., Chen, L., Zhang, X., and Sha, D. (2022). Pretreatment prognostic nutritional index may serve as a potential biomarker in urinary cancers: A systematic review and meta-analysis. Front. Oncol., 12."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sun, J., Li, Z., and Zhu, X. (2024). Prognostic role of prognostic nutritional index in patients with bladder cancer: A systematic review and meta-analysis. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1486389"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/s00345-024-05148-1","article-title":"Preoperative blood-based nutritional biomarkers as significant prognostic factors after intravesical BCG therapy in patients with non-muscle-invasive bladder cancer","volume":"42","author":"Ye","year":"2024","journal-title":"World J. Urol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/992\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:32:45Z","timestamp":1779877965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/992"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050992"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050992","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]}}}