The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy: Validation and Meta-analysis
Abstract
The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC).A high NLR (GREATER-THAN OR EQUAL TO2.7) was associated with advanced pathological tumor stages (p < 0.001), lymph node involvement (p < 0.001), lymphovascular invasion (p = 0.008), and positive soft0tissue surgical margins (p = 0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01-1.22; p = 0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07-1.37, p = 0.003).
The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis.
The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01-1.92) for OS and 1.51 (95% CI 1.17-1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up.In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis.
The NLR may be a readily available and useful biomarker for preoperative prognostic stratification.We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.A high neutrophil/lymphocyte ratio (NLR) seems to be associated with advanced pathologic tumor stages, lymph node involvement, lymphovascular invasion, positive soft-tissue surgical margins, and poorer overall survival and cancer-specific survival.
NLR may become an adjunct to established prognostic markers for clinical decision-making, but further investigations are required.