A mathematical model for predicting tumor recurrence within 24 months following surgery in patients with T1 high-grade bladder cancer treated with BCG immunotherapy

Rubinstein, Jacob; Bar-On, Tomer; Bahouth, Zaher; Shoshany, Ohad; Baniel, Jack; Nativ, Ofer; Halachmi, Sarel

doi:10.14440/bladder.2015.56

Cited by 4 publications

(13 citation statements)

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“…Among patients with bladder cancer, an elevated NLR was associated with advanced stage, increased mortality, and decreased overall survival in patients with muscle-invasive disease [ 9 – 11 ], along with higher risk of recurrence and progression in non-muscle invasive disease [ 12 , 13 ]. Specifically, in both our retrospective studies which employed different methods of analysis, NLR > 2.5 was found to be a significant predictor of recurrence [ 12 , 13 ]. Following these results, and in addition to the fact that prospective data regarding the role of NLR in predicting disease recurrence and progression in NMIBC have never been published, the aim of the current study was to prospectively evaluate the role of NLR > 2.5 as a predictor of disease recurrence in patients with primary NMIBC.…”

Section: Introductionmentioning

confidence: 99%

Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer

et al. 2018

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BackgroundThis study aims to prospectively evaluate the ability of Neutrophil-to-Lymphocyte ratio (NLR) to forecast recurrence in patients with non-muscle invasive bladder cancer (NMIBC). This is a continuation of our two previous retrospective studies that indicated the NLR > 2.5 criterion as a predictor of recurrence in patients with NMIBC.MethodsSince December 2013, all patients admitted to our department for TUR-BT and agreed to participate, had a blood drawn for cell count and differential 24 h prior to surgery. Patients with pathological NMIBC were followed prospectively for disease recurrence. The end-point of the follow up was either a cancer recurrence or the termination of the study. Univariate and multivariate Cox regressions were performed to assess the NLR > 2.5 predictive capability for recurrence, versus and in conjunction to the pathologically based EORTC score, among additional statistical analyses.ResultsThe study cohort included 96 men and 17 women with a median age of 72 years. Sixty-four patients (56.6%) have had a recurrence during the study occurring at the median time of 9 months (IQR 6, 13), while the median follow-up time for patients without recurrence was 18 months (IQR 10, 29). Univariate Cox regressions for recurrence demonstrated significance for NLR > 2.5 for the whole cohort (p = 0.011, HR 2.015, CI 1.175–3.454) and for the BCG sub-group (p = 0.023, HR 3.7, CI 1.2–11.9), while the EORTC score demonstrated significance for the ‘No Treatment’ subgroup (p = 0.024, HR 1.278, CI 1.03–1.58). When analyzed together as a multivariate Cox model, the NLR > 2.5 and EORTC score retained their significance for the aforementioned groups, while also improving the EORTC score significance for the whole cohort.ConclusionNLR > 2.5 was found to be a significant predictor of disease recurrence and demonstrated high hazard ratio and worse recurrence-free survival in patients with NMIBC, especially in those treated with BCG. Additionally, our data demonstrated statistical evidence that NLR > 2.5 might have an improving effect on the EORTC score’s prediction when analyzed together.

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Section: Introductionmentioning

confidence: 99%

Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer

et al. 2018

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“…Overall comparisons between subgroups: p = 0.054. measure, and thus the results are more meaningful. Evidence to this claim can be found in our previous publication, which dealt with a much more 'distilled' cohort [13].…”

Section: Discussionmentioning

confidence: 87%

“…Pretreatment NLR is readily available, and higher values have been shown to correlate with higher stage tumors and adverse treatment outcomes in a wide variety of cancers including malignancies of the gastrointestinal and genitourinary tracts, including urothelial carcinoma of the bladder [6,7,12,13]. Focusing on bladder cancer, several previous studies have evaluated the predictive value of NLR, most of which were conducted on patients undergoing radical cystectomy [9,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Secondary objectives were to evaluate the effect of NLR > 2.5 on disease progression, when stratified by different variables including the pathologic Grade (high and low), Stage (Ta, T1) and the Intra-Vesical Treatment (Yes or No). These objectives were set in advance, and were meant to test the hypothesis that a prediction of disease progression by NLR > 2.5 can be produced prospectively, and not only retrospectively [12,13].…”

Section: Objectivesmentioning

confidence: 99%

“…Among patients with bladder cancer, an elevated NLR was associated with advanced stage, increased mortality, and decreased overall survival in patients with muscle-invasive disease [9][10][11], along with higher risk of recurrence and progression in NMIBC [12,13]. Specifically, in both our retrospective studies which employed different methods of analysis, NLR > 2.5 was found to be a significant predictor of recurrence and progression [12,13]. Based on these results, and in addition to the fact that prospective data regarding the role of NLR in predicting disease recurrence and progression in NMIBC is scarce, the aim of the current study was to prospectively evaluate the role of NLR > 2.5 as a predictor of disease progression in patients with primary NMIBC.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative neutrophil to lymphocyte ratio can improve disease progression prediction of non-muscle invasive bladder cancer

2018

J. Mol. Clin. Med.

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The purpose of this study was prospectively evaluate the ability of Neutrophil-to-Lymphocyte ratio (NLR) to predict disease progression in patients with non-muscle invasive bladder cancer (NMIBC). This is a continuation of our previous retrospective study that indicated the significance of NLR > 2.5 criterion as a predictor of progression in patients with NMIBC. Since December 2013, all patients admitted to Bnai-Zion department for TUR-BT and agreed to participate in the study, had blood analyses for cell count and differential 24hr prior to surgery. Patients with pathological NMIBC were followed prospectively for disease progression. The end-point of the follow up was either a disease progression or the termination of the study. Kaplan-Meier curves and Cox regression were performed to assess the predictive ability of NLR > 2.5 for disease progression. Our results demonstrate a significant difference (p = 0.02) in mean progression-free survival-(35.9 months vs 41.1 months) in the whole cohort Kaplan-Meier survival plot factored by NLR > 2.5. Mean progression-free survival of NLR > 2.5 stratified by stage, grade and treatment (sub-group analysis), showed statistical significance (p = 0.035) for those treated with intra-vesical instillation, and demonstrated a persistent trend for the rest of the stratifications-revealing that the NLR > 2.5 groups always fared worse than the NLR < 2.5 groups. In a univariate analysis, whole cohort Cox regression analysis for disease progression, NLR > 2.5 was found significant (p = 0.05; HR 7.8; CI 1-61), indicating that the probability of progression is increased at least 7-fold for a person with a NLR > 2.5 compared with those with NLR < 2.5. In conclusion, NLR > 2.5 was found to be a significant predictor of disease progression and demonstrated high hazard ratio and worse progression-free survival in patients with NMIBC, especially in those treated with intra-vesical instillation. We propose to consider the incorporation of NLR > 2.5 in the next revisions of the European Organization for Research and Treatment of Cancer (EORTC) scores, given more widely available evidence.

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Morphologic patterns of nodal reactive hyperplasia in primary organ malignancy-architectural changes and evaluation by comparison with other morphological parameters

2023

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Background: Reactive lymph node hyperplasia can exhibit morphological patterns I to VI. This study was done to evaluate lymph node hyperplasia, lymph node reactive patterns, lymph node metastasis and correlation with tumour stage, lymph node patterns and lymph node size. Methods: Total 454 lymph nodes were reviewed for metastases and reactivity patterns I to VI as per the World Health Organization (WHO) protocol. Association between qualitative variables was assessed by the chi-square test and Fisher’s exact test, those between quantitative variables using unpaired t-test. Results: Lymph node hyperplasia was highest in breast and commonest lymph node reactive patterns were lymphocyte predominance, germinal centre predominance, sinus histiocytosis and mixed patterns. Conclusions: Lymph node hyperplasia and lymph node reactive patterns show organ-wise variation and need standardisation. Most common lymph node reactive patterns included lymphocyte predominance and germinal centre predominance hyperplasia. Studying lymph node reactivity may help to understand host immune reaction against the tumour and thus influence prognosis.

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A mathematical model for predicting tumor recurrence within 24 months following surgery in patients with T1 high-grade bladder cancer treated with BCG immunotherapy

Cited by 4 publications

References 24 publications

Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer

Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer

Preoperative neutrophil to lymphocyte ratio can improve disease progression prediction of non-muscle invasive bladder cancer

Morphologic patterns of nodal reactive hyperplasia in primary organ malignancy-architectural changes and evaluation by comparison with other morphological parameters

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