Pre-treatment neutrophil-to-lymphocyte ratio as predictor of adverse outcomes in patients undergoing radical cystectomy for urothelial carcinoma of the bladder

Abstract

Background:An elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor outcome in various tumours. Its prognostic utility in patients with urothelial carcinoma of the bladder (UCB) undergoing radical cystectomy (RC) is yet to be fully elucidated.Methods:A cohort of patients undergoing RC for UCB in a tertiary referral centre between 1992 and 2012 was analysed. Neutrophil-to-lymphocyte ratio was computed using complete blood counts performed pre-RC, or before neo-adjuvant chemotherapy where applicable. Time-dependent receiver operating characteristic curves were used to determine the optimal cutoff point for predicting recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). The predictive ability of NLR was assessed using Kaplan–Meier analyses and multivariable Cox proportional hazards models. The likelihood-ratio test was used to determine whether multivariable models were improved by including NLR.Results:The cohort included 424 patients followed for a median of 58.4 months. An NLR of 3 was determined as the optimal cutoff value. Patients with an NLR⩾3.0 had significantly worse survival outcomes (5y-RFS: 53% vs 64%, log-rank P=0.013; 5y-CSS: 57% vs 75%, log-rank P<0.001; 5y-OS: 43% vs 64%, log-rank P<0.001). After adjusting for disease-specific predictors, an NLR ⩾3.0 was significantly associated with worse RFS (HR=1.49; 95% CI=1.12–2.0, P=0.007), CSS (HR=1.88; 95% CI=1.39–2.54, P<0.001) and OS (average HR=1.67; 95% CI=1.17–2.39, P=0.005). The likelihood-ratio test confirmed that prognostic models were improved by including NLR.Conclusions:Neutrophil-to-lymphocyte ratio is an inexpensive prognostic biomarker for patients undergoing RC for UCB. It offers pre-treatment prognostic value in addition to established prognosticators and may be helpful in guiding treatment decisions.

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

“…The prognostic role of the pretreatment NLR regarding RFS, PFS and disease-specific survival/cancer-specific survival (DSS/CSS) in bladder cancer patients was evaluated in 9, 7 and 9 studies, respectively. Of the 21 included studies, Hermanns’s study reported adjusted HRs and 95% CIs [29], while 3 studies reported HRs and 95% CIs derived only from a univariate analysis [42, 44, 45]; the remaining studies presented HRs and 95% CIs obtained by a multivariate analysis. With regard to the quality assessment of the included studies, the Newcastle-Ottawa Scale (NOS) scores ranged from 6 to 8.…”

Baseline neutrophil‑to‑lymphocyte ratio predicts the prognosis of castration‑resistant prostate cancer treated with abiraterone acetate

“…Patients' background. factors, extracellular matrix-modifying enzymes (which can facilitate invasion and metastasis), and inductive signals (25,26). Cho et al reported that patients with an elevated NLR exhibit a relative lymphocyte-mediated immune response to malignancy, thereby worsening their prognosis and increasing the potential for tumor progression (27,28).…”

Importance of Neutrophil/Lymphocyte Ratio in Prediction of PSA Recurrence after Radical Prostatectomy

“…In a study on patients who underwent radical cystectomy due to invasive bladder tumor, NLR cut-off value was found to be 3,0 and patients with NLR values higher than this had a significantly lower recurrence-free survival (Hermanns et al, 2014) There is a limited number of studies on the relationship between NLR and prostate cancer in the literature (Keizman et al, 2012;Nuhn et al, 2013;Sonpavde et al, 2014;Sumbul et al, 2014). In a study conducted with the participation of 238 patients with castration resistant metastatic prostate cancer, patients with pre-docetaxel treatment NLR values lower than 3 responded better to treatment and had significantly higher total survival compared to patients with NLR values higher than 3 (Nuhn et al, 2013).…”

“…In previous studies, it has been found that increased NLR was associated with poor prognosis and low survival in various cancer types (Sonpavde et al, 2014). In recent years, the relationship between NLR and urological malignancies has been studied and it has been found that NLR was associated with poor prognosis in renal, bladder and castration resistant prostate cancer as well as other cancer types (Cetin et al, 2013;Sonpavde et al, 2014;Hermanns et al, 2014). It is reported that NLR can predict benigh prostate hyperplasia progression (Tanik et al, 2014).…”