Validation of the pretreatment derived neutrophil–lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma

Abstract

Background:The value of a combined index of neutrophil and white cell counts, named derived neutrophil–lymphocyte ratio (dNLR), has recently been proposed as a prognosticator of survival in various cancer types. We investigated the prognostic role of the dNLR in a large European cohort of patients with upper tract urothelial carcinoma (UTUC).Methods:Data from 171 non-metastatic UTUC patients, operated between 1990 and 2012 at a single tertiary academic centre, were evaluated retrospectively. Cancer-specific- (CSS) as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of the dNLR, multivariate proportional Cox-regression models were applied. Additionally, the influence of the dNLR on the predictive accuracy of the multivariate model was further determined by Harrell's concordance index (c-index).Results:The median follow-up period was 31 months. An increased dNLR was statistically significantly associated with shorter CSS (log-rank P=0.004), as well as with shorter OS (log-rank P=0.002). Multivariate analysis identified dNLR as an independent predictor for CSS (hazard ratio, HR=1.16, 95% confidence interval, CI=1.01–1.35, P=0.045), as well as for OS (HR=1.21, 95% CI=1.09–1.34, P<0.001). The estimated c-index of the multivariate model for OS was 0.68 without dNLR and 0.73 when dNLR was added.Conclusions:Patients with a high pretreatment dNLR could be predicted to show subsequently higher cancer-specific- as well as overall mortality after surgery for UTUC compared with those with a low pretreatment dNLR. Thus, this combined index should be considered as a potential prognostic biomarker in future.

Prognostic performance of inflammation-based prognostic indices in patients with resectable colorectal liver metastases

“…Subsequently, Absenger et al [37] confirmed that the preoperative dNLR was an independent adverse prognostic marker for both time to recurrence and overall survival in patients with operable stage II/III colon cancer. The prognostic significance of the dNLR has since been validated in breast cancer [39], upper tract urothelial carcinoma [38], B cell lymphoma [41] and pancreatic adenocarcinoma [40], suggesting that it is a valid inflammatory biomarker across a range of cancer types. In the current study, we confirm that the dNLR is also an independent prognostic factor in b Fig.…”

“…To obviate this problem and allow the widespread utilisation of the NLR, Proctor et al [36] implemented a derived score, the derived neutrophil-lymphocyte ratio (dNLR), composed of neutrophil count divided by white cell count minus neutrophil count, and were able to demonstrate similar prognostic value to the established NLR across a range of malignancies. Subsequent studies have confirmed its prognostic significance in several other cancer types [37][38][39][40][41], but it has yet to be validated in the context of resectable CRLM.…”

The derived neutrophil/lymphocyte ratio predicts poor clinical outcome in soft tissue sarcoma patients

“…In patients with upper tract urothelial carcinoma, a high pretreatment dNLR showed subsequently higher cancerspecific as well as overall mortality after surgery compared with those with a low pretreatment dNLR. 24 To the best of our knowledge, in STS patients, such an external validation of the dNLR has not been reported. In this study, we determined a cut-off value of 2.39 for the dNLR to be optimal for our study cohort of 340 STS patients and demonstrated for the first time that elevated dNLR correlates significantly and independently with poor OS.…”

804 Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy

“…Finally, we only investigated NLR. A growing evidence suggests that derivatives of NLR or its combination with other preoperative markers of systemic inflammation may be helpful in the prediction of oncologic outcomes in UTUC and warrants further investigations [29][30][31].…”