The TNR-C score (tumor stage, lymph node density, resection margin status, and serum CRP) correlates with cancer specific survival (CSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). Our retrospective single center study aimed to evaluate CRP as a prognostic parameter in patients with BCa undergoing RC, to externally validate the TNR-C score, and based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC

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... at can identify patients with a high risk of progression. Material and methods: In total, 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed. The clinicopathologic parameters assessed included age; comorbidities; pre-/postoperative serum levels of CRP; leucocytes; hemoglobin; creatinine; urinary diversion; tumor grading, staging, and lymph node status; lymph node density (LND); lymphovascular invasion (LVI); metastases; and resection margin status. Regarding outcome, overall survival (OS) was assessed. Results: Single parameters of the TNR-C-score, such as T-stage (p=0.012) and R-status (p=0.002), were independent prognostic parameters for overall survival (OS). Univariate analysis showed a significant association of OS with the T-stage ( pT2, p=0.001), R-status (p<0.001), LVI (p=0.011), and preoperative CRP level (p=0.02). The multivariate analysis excluding lymph node (LN) positive and metastatic patients showed a significant association of the R-status (R; p<0.001), LVI (L; p=0.021), and preoperative CRP level >5 mg/L (C; p=0.008) with OS. Based on these parameters, the RLC-score was developed. The median OS in the low, intermediate, and high-risk groups according to the RLC score was