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| Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer |
| Yu Guang Tan, Ernest Eu, Weber Lau Kam On, Hong Hong Huang
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| Department of Urology, Singapore General Hospital, Singapore |
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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.
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Received: 12 June 2016
Published: 26 October 2017
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