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. 2020 Dec 22:12:13125-13135.
doi: 10.2147/CMAR.S283954. eCollection 2020.

The Significance of Neutrophil-to-Lymphocyte Ratio and Combined Chemoradiotherapy in Patients Undergoing Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Chun-Te Wu  1   2 , Yun-Ching Huang  2   3 , Wen-Cheng Chen  2   4 , Miao-Fen Chen  2   4
Affiliations

The Significance of Neutrophil-to-Lymphocyte Ratio and Combined Chemoradiotherapy in Patients Undergoing Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Chun-Te Wu et al. Cancer Manag Res. .

Abstract

Background: Bladder-sparing treatment has been developed with the aim of preserving bladder function. However, considerable controversy remains regarding the effectiveness of organ preservation strategies. Accordingly, we investigated factors influencing the prognosis of muscle-invasive bladder cancer (MIBC) patients who received bladder-sparing treatment.

Materials and methods: In the study, we retrospectively reviewed 193 patients who were newly diagnosed with MIBC and received bladder-sparing treatment from 2006 to 2013 in our hospital.

Results: The 5-year overall survival, progression-free survival (PFS) and bladder-preservation survival rates after diagnosis were 64.7%, 52.1%, and 64%, respectively. The presence of hydronephrosis, advanced stage and not achieving complete response were associated with a marked reduction in PFS. Treatment with an adequate dose of combined chemoradiotherapy (CCRT) (chemotherapy ≥2 cycles combined with radiotherapy dose ≥56Gy) significantly improved the complete response (CR), 5-year bladder-preservation survival, and PFS rates, particularly for patients with good performance status. The 5-year bladder-preservation survival rates for CR and non-CR patients were 75%, and 21%, respectively. Furthermore, higher pre-treatment neutrophil-to-lymphocyte ratio (NLR) (≥3) and lower hemoglobin (≤12) were significantly associated with lower CR rate, increased risk of loco-regional recurrence and reduced bladder-preservation survival rate. Multivariable Cox regression analysis based on different co-variables showed that pretreatment NLR was an independent prognostic factor for PFS when MIBC patients were stratified by clinical stage and the doses of CCRT.

Conclusion: In MIBC patients with bladder-sparing treatment, adequate doses of CCRT and low NLR were found to be correlated with better PFS. We suggest the use of NLR as a clinical biomarker for the prognosis of MIBC and guidance of treatment decisions.

Keywords: MIBC; NLR; bladder-sparing; radiotherapy; recurrence.

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Conflict of interest statement

The authors declare that they have no conflicts of interest for this work.

Figures

Figure 1
Figure 1
Survival of MIBC patients treated with bladder-sparing treatment. (A) Kaplan-Meier survival curves of the patients with MIBC in total; and the PFS differences according to (B) the cycles of chemotherapy and (C) the dose of RT. Furthermore, the PFS differences according to (D) the cycles of chemotherapy in patients stratified with ECOG and the dose of RT.
Figure 2
Figure 2
Correlations between the bladder-preservation survival and the response to bladder-sparing treatment Kaplan-Meier survival curves of the patients with MIBC; and the difference of bladder-preserving survival according to (A) the response to bladder-sparing treatment, (B) the presence of hydronephrosis, and (C) the doses of chemotherapy and RT.
Figure 3
Figure 3
Correlations between the pre-treatment NLR and the prognosis. (A) The difference of NLR values according to the response to bladder-sparing treatment. (B) The difference of Hb values according to the response to bladder-sparing treatment. (C) The differences of loco-regional control according to the pre-treatment NLR and Hb (D) The difference of bladder-preservation survival according to the pre-treatment NLR and Hb.
Figure 4
Figure 4
Correlations between the PFS and the value of NLR and Hb. (A) The difference of PFS according to the value of NLR stratified by Hb (solid line, Hb>12; dotted line, Hb ≤12; blue, NLR<3; yellow, NLR≥ 3). (B) NLR associated with PFS when MIBC patients were stratified by clinical factors in multivariate model. *p<0.05.
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References

    1. Witjes JA, Comperat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014;65(4):778–792. doi:10.1016/j.eururo.2013.11.046 - DOI - PubMed
    1. Gakis G, Efstathiou J, Lerner SP, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2013;63(1):45–57. doi:10.1016/j.eururo.2012.08.009 - DOI - PubMed
    1. Mathieu R, Lucca I, Klatte T, Babjuk M, Shariat SF. Trimodal therapy for invasive bladder cancer: is it really equal to radical cystectomy? Curr Opin Urol. 2015;25(5):476–482. doi:10.1097/MOU.0000000000000203 - DOI - PubMed
    1. Hautmann RE, de Petriconi RC, Pfeiffer C, Volkmer BG. Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol. 2012;61(5):1039–1047. doi:10.1016/j.eururo.2012.02.028 - DOI - PubMed
    1. Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol. 2001;19(3):666–675. doi:10.1200/JCO.2001.19.3.666 - DOI - PubMed