Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer

Abstract

ObjectiveTo determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.MethodsWe retrospectively reviewed 84 patients undergoing radical cystectomy (RC) for UCB from January 2002 to June 2012. NLR was computed (median: 5 days) prior to surgery. No patients received neoadjuvant chemotherapy. NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained, with a statistical receiver operating characteristics of 0.74. Kaplan–Meier curves, multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes.ResultsThe median follow-up period was 30.1 months (range: 3.2–161.7) owing to high recurrence rate and subsequent mortalities, compared to the median 64.7 months in patients alive at the end of study period. NLR ≥2.7 was associated with worse survival outcomes (5-year disease-specific survival: 22% vs 58%, p = 0.017, 95%CI: 1.193–6.009; 5-year overall survival: 23% vs 60%, p = 0.008, 95%CI: 1.322–6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate (p = 0.007, HR =6.999, 95%CI: 1.712–28.606), higher T staging (p = 0.021, HR = 3.479, 95%CI: 1.212–9.990) and lymph node involvement (p = 0.009, HR = 4.534, 95%CI: 1.465–14.034).ConclusionThis study suggests that NLR can be an inexpensive novel factor for patients risk stratification pre-operatively. This improves patient counseling and identifies patients who may benefit from multimodal treatment.

Neutrophil-to-lymphocyte ratio as a predictor of overall survival and cancer advancement in patients undergoing radical cystectomy for bladder cancer

“…In our study an NLR >2.7 was also associated with poor OS, with a mean of 19.2 months vs 45.6 months (log rank test 0.03). Similar results were obtained by Tan et al (22.3 months vs 64.8 months) [ 31 ]. However, we could not define NLR as an independent prognostic factor for overall survival, as we obtained statistical significance only in univariate analysis.…”

Blood-Based Biomarkers as Prognostic Factors of Recurrent Disease after Radical Cystectomy: A Systematic Review and Meta-Analysis

“…Urothelial cancer patients with preoperatively increased NLR exhibited increased rates of disease recurrence after radical surgery compared to patients with lower NLR. Except for one publication by Mari et al, six articles included in this meta-analysis reported a statistically significant negative correlation of elevated NLR with RFS [ 20 , 21 , 22 , 32 , 33 , 36 , 45 ]. These results support the integration of NLR for risk stratification tools and could help guide decision-making, especially regarding treatment intensification.…”

Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in penile cancer: A systematic review and meta-analysis

“…Among advanced/metastatic bladder cancer patients, NLR could independently improve the prediction of survival outcomes. Higher NLR is strongly linked to a poorer OS, with a HR of 5.06 in one study and the CSS of 36% lower in another study [ 30 , 31 ]. The patients with an NLR of ≤3.0 are likely to have better cancer outcomes and attain greater survival improvement from chemotherapy compared to the group with NLR of >3.0.…”