DIAGNOSTIC AND PROGNOSTIC UTILITY OF COMPLETE BLOOD COUNT-DERIVED INFLAMMATORY MARKERS AND C-REACTIVE PROTEIN IN PENILE CANCER
DOI:
https://doi.org/10.22551/MSJ.2026.02.11Abstract
Systemic inflammatory indicators obtained from standard blood tests have garnered heightened interest as prospective diagnostic and prognostic instruments in oncological urology. Materials and methods: This study assessed the diagnostic efficacy of complete blood count-derived inflammatory indices and C-reactive protein (CRP) in individuals with penile cancer. A total of 38 individuals with penile cancer were compared to 38 control participants receiving surgery for benign scrotal conditions. Results: Notable disparities were identified between the two groups for baseline characteristics. Patients with penile cancer were much older and had reduced blood hemoglobin levels and elevated serum creatinine values in comparison to controls. All assessed inflammatory markers were markedly enhanced in the cancer cohort, suggesting an increased systemic inflammatory load. Mean CRP levels were significantly elevated in patients with malignancy, accompanied by markedly higher neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). An examination of the ROC curves for inflammatory markers revealed statistically significant differences between groups. The NLR exhibited strong discriminating capacity for penile cancer, with an area under the curve (AUC) of 0.829. CRP had significant diagnostic efficacy (AUC 0.700). Conversely, composite indices such as SIRI and AISI showed relatively little discriminatory ability, with AUC values of 0.694 and 0.697, respectively. Conclusions: Individuals with penile cancer exhibit markedly increased systemic inflammatory markers in comparison to controls. Among the assessed indices, NLR and CRP demonstrated the greatest diagnostic efficacy, whereas more complex composite indices provided minimal additional differentiation.
References
1. Czajkowski M, Wierzbicki PM, Dolny M, Matuszewski M, Hakenberg OW. Inflammation in Penile Squamous Cell Carcinoma A Comprehensive Review. Int J Mol Sci 2025; 26(6): 2785/ doi: 10.3390/ ijms26062785.
2. Babadi S, Shahri MM, Nematollahi SF, et al. Relationship between NLR and penile squamous cell carcinoma: a systematic review and meta-analysis. BMC Urol 2024; 24(1): 194 / doi: 10.1186/s12894-024-01569-7.
3. Qin T, Du S, Zhang K, et al. Evaluation of C-reactive protein levels in patients with penile cancer: a systematic review and meta-analysis. World J Surg Oncol 2025; 23(1): 78 / doi: 10.1186/s12957-025-03664-x.
4. Mjaess G, Chebel R, Karam A, et al. Prognostic role of neutrophil-to-lymphocyte ratio (NLR) in urological tumors: an umbrella review of evidence from systematic reviews and meta-analyses. Acta Oncol 2021; 60(6): 704-713 / doi: 10.1080/0284186X.2021.1886323.
5. Kong F, Huang J, Xu C, Huang T, Wen G, Cheng W. System inflammation response index: a novel inflammatory indicator to predict all-cause and cardiovascular disease mortality in the obese population. Diabetol Metab Syndr. 2023; 15(1): 195 / doi: 10.1186/s13098-023-01178-8.
6. Hayama T, Ochiai H, Ozawa T, et al. High systemic inflammation response index (SIRI) level as a prognostic factor for colorectal cancer patients after curative surgery: a single-center retrospective analysis. Sci Rep 2025; 15(1): 1008 / doi: 10.1038/s41598-024-84991-z.
7. Xiu J, Lin X, Chen Q, et al. The aggregate index of systemic inflammation (AISI): a novel predictor for hypertension. Front Cardiovasc Med 2023; 10: 1163900 / doi: 10.3389/fcvm.2023.1163900.
8. Puia D, Ivănuță M, Pricop C. Kidney Injury Molecule-1 as a Biomarker for Renal Cancer: Current Insights and Future Perspectives-A Narrative Review. Int J Mol Sci 2025; 26(7): 3431/ doi: 10.3390/ ijms26073431.
9. Puia D, Ivănuță M, Pricop C. DNA Methylation in Bladder Cancer: Diagnostic and Therapeutic Per-spectives-A Narrative Review. Int J Mol Sci 2025; 26(15): 7507 / doi: 10.3390/ijms 26157507.
10. Puia D, Ivănuță M, Cauni VM, Corlade-Andrei M, Pricop C. Complete Blood Count-Derived In-flammatory Markers and C-Reactive Protein in Testicular Cancer: Diagnostic and Prognostic Utility. Med Sci (Basel) 2025; 13(4): 274 / doi: 10.3390/medsci13040274.
11. Toh E, Wilson J, Sebag-Montefiore D, Botterill I. Neutrophil: lymphocyte ratio as a simple and novel biomarker for prediction of locoregional recurrence after chemoradiotherapy for squamous cell carci-noma of the anus. Colorectal Dis 2014; 16(3): O90-7 / doi: 10.1111/codi.12467.
12. Chaux A, Canete-Portillo S. Molecular Pathology and Biomarkers of Penile Squamous Cell Carcinoma: Implications for Classification and Management. Surg Pathol Clin 2025; 18(1): 13-24 / doi: 10.1016/j path.2024.12.001.
13. Hu C, Bai Y, Li J, et al. Prognostic value of systemic inflammatory factors NLR, LMR, PLR and LDH in penile cancer. BMC Urol 2020; 20(1): 57 / doi: 10.1186/s12894-020-00628-z.
14. Steffens S, Al Ghazal A, Steinestel J, et al. High CRP values predict poor survival in patients with penile cancer. BMC Cancer 2013; 13: 223 / doi: 10.1186/1471-2407-13-223.
15. Pizzocaro G, Algaba F, Horenblas S, et al. European Association of Urology (EAU) Guidelines Group on Penile Cancer. EAU penile cancer guidelines 2009. Eur Urol 2010; 57(6): 1002-10012 / doi: 10.1016/j.eururo.2010.01.039.
16. Huang J, Baum Y, Alemozaffar M, et al. C-reactive protein in urologic cancers. Mol Aspects Med 2015; 45: 28-36 / doi: 10.1016/j.mam.2015.04.001.
17. Miron A, Jinga V, Rădăvoi GD, et al. Preoperative C-reactive protein is related with renal cell tumor dimension? Preliminary results. Rom J Morphol Embryol 2022; 63(4): 639-644 / doi: 10.47162/RJME. 63.4.06.
18. Naushad N, Deb AA, Agag AA, Serag HA, Sangar VK. Prognostic Markers and Trials in Penile Cancer. Urol Res Pract 2023; 49(3): 138-146 / doi: 10.5152/tud.2023.22225.
19. Li ZS, Chen P, Yao K, Wang B, et al. Development of a new outcome prediction model for Chinese patients with penile squamous cell carcinoma based on preoperative serum C-reactive protein, body mass index, and standard pathological risk factors: the TNCB score group system. Oncotarget. 2016; 7(15): 21023-33 / doi: 10.18632/oncotarget.8037.
20. Li ZS, Yao K, Li YH, et al. Clinical significance of preoperative C-reactive protein and squamous cell carcinoma antigen levels in patients with penile squamous cell carcinoma. BJU Int 2016; 118(2): 272-278 / doi: 10.1111/bju.13379.
21. Azizi M, Peyton CC, Boulware DC, et al. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Penile Squamous Cell Carcinoma Patients Undergoing Inguinal Lymph Node Dissection. Eur Urol Focus 2019; 5(6): 1085-1090 / doi: 10.1016/j.euf.2018.06.008.
22. Ottenhof SR, Djajadiningrat RS, Thygesen HH, et al. The Prognostic Value of Immune Factors in the Tumor Microenvironment of Penile Squamous Cell Carcinoma. Front Immunol 2018; 9: 1253 / doi: 10.3389/fimmu.2018.01253.
Additional Files
Published
Issue
Section
License
Copyright (c) 2026 The Medical-Surgical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form
