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. 2017 Oct;4(4):239-246.
doi: 10.1016/j.ajur.2017.01.004. Epub 2017 Mar 29.

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

Yu Guang Tan  1 , Ernest Eu  1 , Weber Lau Kam On  1 , Hong Hong Huang  1
Affiliations

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

Yu Guang Tan et al. Asian J Urol. 2017 Oct.

Abstract

Objective: To determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.

Methods: We 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.

Results: The 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).

Conclusion: This 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.

Keywords: Bladder cancer; Bladder carcinoma; Neutrophil-to-lymphocyte ratio; Radical cystectomy.

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Figures

Figure 1
Figure 1
Disease-specific survival. NLR, neutrophil-to-lymphocyte; LN, lymph node.
Figure 2
Figure 2
Overall survival. NLR, neutrophil-to-lymphocyte; LN, lymph node.
Figure 3
Figure 3
NLR and possible treatment options. NLR, neutrophil-to-lymphocyte ratio; TURBT, transurethral resection of bladder tumor.
See this image and copyright information in PMC

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