Perioperative change in neutrophil–lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy

Yoshida, Takashi; Kinoshita, Hidefumi; Yoshida, Kenji; Mishima, Takao; Yanishi, Masaaki; Komai, Yoshihiro; Sugi, Motohiko; Mizutani, Takashi; Kawa, Gen; Matsuda, Tadashi

doi:10.1093/jjco/hyw129

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…An increase of NLR or PLR during or after therapy was associated with poorer total and disease-free survival (DFS) in several studies ( 70 , 72 , 73 ). Simultaneously, patients had a better prognosis if NLR decreased after chemotherapy or targeted therapy ( 69 , 73 ). Therefore, also dynamic changes of PLR and NLR seem to be prognostically relevant.…”

Section: Discussionmentioning

confidence: 99%

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer—single center experience and review of the literature

Wersal

Keller

Weiß

et al. 2019

Transl. Cancer Res.

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Background: Intraoperative radiotherapy (IORT) for breast cancer is used as an upfront boost or as accelerated partial breast irradiation (APBI). To date, no description of blood count changes after IORT are available. Our analysis shows blood count changes in breast cancer patients up to 5 years after IORT ± whole breast radiotherapy (WBRT).Methods: IORT was given as APBI in 58 patients (IORT/APBI-group) and as a boost in 198 patients (IORT/WBRT-group). A median dose of 20 Gy was given intraoperatively with low energy X-rays [INTRABEAM (TM) System] and additionally 46 Gy/2 Gy per fraction to the whole breast, if WBRT was added. Blood counts were collected preoperatively, after 90 days and through year 1-5 of followup. Dunnett's tests were used to calculate changes in blood counts over time. Additionally, platelet-tolymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated for each time point.Results: Significantly decreases in the IORT/WBRT-group were seen for erythrocytes, hemoglobin, platelets and leucocytes and an increase for lymphocytes for the total follow-up period. In the IORT/APBIgroup significantly decreases were seen for erythrocytes and hemoglobin for the total follow-up period.Regarding changes during follow-up compared to the preoperative value, much more significant changes were seen in the IORT/WBRT-group compared to IORT/APBI-group without any relevant impact of chemotherapy. Regarding PLR-, NLR-and dNLR-values the rate of patients over the range improved over time in both groups.Conclusions: IORT/APBI seems to have a smaller effect on blood counts compared to IORT/WBRT. Furthermore, PLR-, NLR-and dNLR-values improved over time, suggesting a positive effect on outcome after IORT in general.

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Section: Discussionmentioning

confidence: 99%

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer—single center experience and review of the literature

Wersal

Keller

Weiß

et al. 2019

Transl. Cancer Res.

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“…This also did not evaluate patients who received NAC. In another study, perioperative changes in NLR were significantly associated with OS in patients undergoing radical cystectomy, and patients with a high post-operative NLR who had a decrease in NLR after adjuvant chemotherapy had improved outcomes [ 27 ]. However, the clinical applicability of this data is limited by the fact that current guidelines recommend NAC rather than adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study found that a pre-treatment NLR < 2.5 could predict for better progression-free survival, cancer-specific survival, overall survival, and pathologic response in MIBC patients undergoing NAC [ 26 ]. Although perioperative changes in NLR are associated with survival, the change in NLR during NAC and its impact on outcomes is not fully understood [ 27 ]. The objectives of this study were to evaluate the prognostic role of baseline NLR on outcomes and the impact of the change in NLR over the course of NAC on outcomes in patients with MIBC.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Role of the Change in Neutrophil-to-Lymphocyte Ratio During Neoadjuvant Chemotherapy in Patients with Muscle-Invasive Bladder Cancer: A Retrospective, Multi-Institutional Study

Kaiser

North²,

Leibowitz-Amit

et al. 2018

BLC

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Background:The impact of the change in the neutrophil-to-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NAC) on outcomes in patients with muscle-invasive bladder cancer (MIBC) is poorly understood.Objective:To evaluate the prognostic impact of the change in NLR during NAC for patients with MIBC.Methods:Patients referred to academic, community, and quaternary referral centres in Alberta, Canada from 2005 to 2015, Ontario, Canada from 2005 to 2013, and Southampton, UK from 2004 to 2010 were evaluated. 376 eligible patients were treated with NAC for clinical T2-4aN0M0 disease, and 296 were evaluable for the change in NLR. A high NLR was defined as being an NLR > 3. Relationships between the change in NLR from baseline to mid-NAC (pre-cycle 3) and outcomes were analyzed using multivariable Cox regression. Kaplan-Meier analysis was used with the log-rank test for group comparisons.Results:Median follow-up was 22.0 months (95% confidence interval [CI]: 14.9–30.0). Patients with a sustained high NLR had a median disease-free survival (DFS) of 12.6 months, compared to 34.8 months for those with a sustained low NLR (log-rank test p = 0.0025; hazard ratio [HR] 0.61 [95% CI: 0.44–0.84]). Median overall survival (OS) was 19.4 months for patients with a sustained high NLR, compared to 44.0 months for patients with a sustained low NLR (log-rank test p = 0.0011; HR 0.54 [95% CI: 0.38–0.77]).Conclusions:A sustained high NLR from baseline to mid-NAC is an independent prognostic factor for patients with MIBC.

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“…Full-text reviews were performed by the two investigators. Finally, 38 studies were selected for meta-analysis ( Figure 2), including seven articles on TURBT (6,7,(15)(16)(17)(18)(19), 15 on radical cystectomy (8)(9)(10)(11)(12)(20)(21)(22)(23)(24)(25)(26)(27)(28), five on chemotherapy (29)(30)(31)(32)(33), and 11 on nephroureterectomy for upper ureter urothelial carcinoma (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44).…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

Clinical Significance of Pre-treated Neutrophil-Lymphocyte Ratio in the Management of Urothelial Carcinoma: A Systemic Review and Meta-Analysis

et al. 2019

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Purpose: We performed a study-level meta-analysis to summarize the current evidence on the correlation between pretreatment neutrophil-to-lymphocyte ratios (NLR) and oncological outcomes in each type of management for urothelial carcinoma. Method: All articles published until February 2017 in PubMed, Scopus, and EMBASE database were collected and reviewed. The current evidence on correlations between pretreatment NLR and oncological outcomes in each type of management for urothelial carcinoma, including transurethral resection of bladder tumor (TURBT), radical cystectomy (RCx), chemotherapy (CTx), and nephroureterectomy (NUx), were summarized. Results: Thirty-eight studies containing clinical information on 16,379 patients were analyzed in this study. Pooled hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals were calculated after weighing each study. Heterogeneity among the studies and publication bias were assessed. Pretreatment NLR was significantly associated with muscle invasiveness (OR: 4.27), recurrence free survival (RFS, HR: 2.32), and progression-free survival (PFS, HR: 2.45) in TURBT patients. In the RCx patients, high NLR was negatively associated with both disease status (extravesical extension and lymph-node positivity, OR: 1.14 and 1.43, respectively) and oncological outcomes [overall survival (OS), PFS], and cancer specific survival (CSS, HR: 1.18, 1.12, and 1.35, respectively). Pretreatment NLR was negatively correlated with pathologic downstaging (OR: 0.79) and positively correlated with PFS (HR: 1.30) and OS (HR: 1.44) in CTx patients. For patients who underwent NUx, pretreatment NLR was significantly associated with OS (HR: 1.72), PFS (HR: 1.63), and CSS (HR: 1.68). Conclusions: Pretreatment NLR is a useful biomarker for disease aggressiveness, oncological outcome, and treatment response in the management of patients with urothelial carcinoma. More evidence is needed to clarify these results.

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Perioperative change in neutrophil–lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy

Abstract: Perioperative changes in neutrophil-lymphocyte ratio are significantly associated with overall survival in patients with bladder cancer undergoing radical cystectomy. Follow-up of the neutrophil-lymphocyte ratio change may be useful for the clinical management of patients after surgery.

Cited by 10 publications

References 22 publications

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer—single center experience and review of the literature

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer—single center experience and review of the literature

The Prognostic Role of the Change in Neutrophil-to-Lymphocyte Ratio During Neoadjuvant Chemotherapy in Patients with Muscle-Invasive Bladder Cancer: A Retrospective, Multi-Institutional Study

Clinical Significance of Pre-treated Neutrophil-Lymphocyte Ratio in the Management of Urothelial Carcinoma: A Systemic Review and Meta-Analysis

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