A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

Abstract

This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.

804 Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy

“…However, adjusted for standard pathologic prognostic factors in UTUC, NLR did not retain statistical significance. Most of the previous studies reported, however, independent predictive value for RFS [15], CSS [13,14] and OS [14]. The discrepancies between these studies and our findings could be explained by several reasons.…”

“…Altered NLR was associated with features of biologically and clinically aggressive UTUC such as advanced tumor stage, LVI, tumor necrosis, sessile architecture and lymph node metastases. These findings confirm the results reported in smaller cohorts [13][14][15]. The potential reasons for such associations remain hypothetical.…”

“…First, initial studies defined the optimal cutoff for NLR as 2.7 [14] or 3 [13] based on the interpretations of iterative Cox or ROC analysis observed in the cohorts. Only one study externally validated the prognostic value of NLR using a predefined threshold of 3 [15]. To our knowledge, we are the first to propose an external validation with the 2.7 cutoff proposed by Dalpiaz et al [14].…”

“…Luo et al [13] only included patients with pT stage <4 and We demonstrated, however, that NLR would be an independent prognostic factor regarding CSS in patients who were treated with lymphadenectomy. In previous studies, status of lymphadenectomy was not routinely performed [13][14][15]. Staging benefit of lymphadenectomy in UTUC is noteworthy [26].…”

“…In urological neoplasms, its prognostic value has been also reported in bladder cancer [11] and renal cell carcinoma [12]. In UTUC, evidence regarding its prognostic value is, however, limited to recent retrospective studies with relatively small cohorts [13][14][15], and none is known about its ability to predict adverse pathological features.…”