Neutrophil-to-lymphocyte ratio is a prognostic marker in bladder cancer patients after radical cystectomy

Abstract

BackgroundThere is no reliable biomarker for predicting the prognosis of patients who undergo radical cystectomy for bladder cancer. Recent studies have shown that the neutrophil-to-lymphocyte ratio (NLR) could function as a useful prognostic factor in several types of malignancies. This study aimed to assess the usefulness of NLR in bladder cancer.MethodsA total of 74 patients who underwent radical cystectomy in our institutions from 1999 to 2014 were analyzed. The NLR was calculated using the patients’ neutrophil and lymphocyte counts before radical cystectomy. An immunohistochemical analysis was also performed to detect tumor infiltrating neutrophils (CD66b) and lymphocytes (CD8) in bladder cancer specimens.ResultsA univariate analysis showed that the patients with a high NLR (≥2.38; HR = 4.84; p = 0.007), high C-reactive protein level (>0.08; HR = 10.06; p = 0.030), or pathological lymph node metastasis (HR = 4.73; p = 0.030) had a significantly higher risk of cancer-specific mortality. Kaplan-Meier and log-rank tests further revealed that NLR was strongly correlated with overall survival (p = 0.018), but not progression-free survival (p = 0.137). In a multivariate analysis, all of these were found to be independent risk factors (HR = 4.62, 10.8, and 12.35, respectively). The number of CD8-positive lymphocytes was significantly increased in high-grade (p = 0.001) and muscle-invasive (p = 0.012) tumors, in comparison to low-grade and non-muscle-invasive tumors, respectively.ConclusionsThe NLR predicted the prognosis of patients who underwent radical cystectomy and might therefore function as a reliable biomarker in cases of invasive bladder cancer.

The neutrophil-to-lymphocyte ratio is an effective prognostic marker in localized upper urinary tract urothelial carcinoma treated with nephroureterectomy

“…Some of these studies revealed correlations between NLR and prognosis of patients with UUT-UC who underwent nephroureterectomy [17][18][19][20]. In urothelial carcinoma, our previous reports showed the cut-off points as 2.38 for the patients who received radical cystectomy and the other reports in bladder cancer showed similar cut-off point (2.38 -3.0) [11]. For UUT-UC, the cut-off points were 2.5 to 2.7 [19,20].…”

“…In particular, C-reactive protein as a systemic inflammation marker was reported to be a poor prognostic factor in several types of cancers [6,7]. Others and we have also revealed that neutrophil-to-lymphocyte ratio (NLR) is an independent prognostic factor in various solid malignancies, including renal cell carcinoma, bladder urothelial carcinoma, and prostatic carcinoma [8][9][10][11][12][13]. Of note, NLR can be easily calculated from complete blood counts (CBCs) in the peripheral blood, and this parameter can be used both pre-and post-operatively.…”

Pretreatment Neutrophil-to-Lymphocyte Ratio Can Predict the Prognosis in Bladder Cancer Patients Who Receive Gemcitabine and Nedaplatin Therapy

“…CBCs are typically examined during the clinical check-up, and the NLR can be applied to all patients virtually either before or after surgery/medical treatment. We previously reported NLR as an independent prognosticator in men presenting with metastatic prostate cancer as well as in bladder cancer patients who received radical cystectomy [14]. Indeed, NLR has been shown to be a prognostic factor in patients with bladder cancer [12, 15–19].…”

“…We previously assessed the utility of NLR as a biomarker to predict tumor recurrence and cancer death in bladder cancer patients who underwent radical cystectomy [14]. In the current study, we investigated whether NLR could predict the prognosis of bladder cancer patients who received gemcitabine and nedaplatin (GN) chemotherapy.…”

Predictive role of neutrophil-to-lymphocyte ratio on upstaging of organ-confined invasive urothelial bladder cancer to non-organconfined disease

“…[23,24] Kawahara et al [25] showed that the NLR was an independent prognostic factor in bladder cancer patients who underwent RC. Potretzke et al [11] demonstrated that patients with preoperative NLR elevation could be upstaged at the time of RC and might benefit from neo-adjuvant chemotherapy.…”