Pretreatment Neutrophil-to-Lymphocyte Ratio Is Associated with Advanced Pathologic Tumor Stage and Increased Cancer-specific Mortality Among Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy

Viers, Boyd R.; Boorjian, Stephen A.; Frank, Igor; Tarrell, Robert F.; Thapa, Prabin; Karnes, R. Jeffrey; Thompson, R. Houston; Tollefson, Matthew K.

doi:10.1016/j.eururo.2014.02.042

Cited by 177 publications

(173 citation statements)

References 27 publications

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“…An elevated NLR before cystectomy has been associated with decreased overall and DSS. [6][7][8][9][10] In our study, NLR was significantly associated with DSS similar to previous reports. 6,10 In contrast, Demirtas and colleagues did not find a significant association between patients with an NLR >2.5 and overall survival.…”

Section: Discussionsupporting

confidence: 81%

“…[6][7][8][9][10] In our study, NLR was significantly associated with DSS similar to previous reports. 6,10 In contrast, Demirtas and colleagues did not find a significant association between patients with an NLR >2.5 and overall survival. 15 On the other hand, a hematopoietic parameter, leukocytosis, which may be a possible prognostic factor, has largely been limited to individual case reports of paraneoplastic syndromes within the published data on urothelial carcinoma.…”

Section: Discussionsupporting

confidence: 81%

“…5 Neutrophil count, lymphocyte count or neutrophil-to-lymphocyte ratio (NLR) can be independent prognostic and predictive systematic inflammatory markers for unfavourable survival in patients with urinary tract malignancies. [6][7][8][9] Although elevated NLR and poor overall and disease-specific survival (DSS) in muscle-invasive disease have been reported, 10 to date, the prognostic significance of leukocytosis in patients with bladder carcinoma treated with radical cystectomy has not yet been determined. Therefore, we evaluated the prognostic impact of preoperative leukocytosis in patients with bladder carcinoma treated with radical cystectomy.…”

Section: Introductionmentioning

confidence: 99%

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The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer

Özcan

Telli

Öztürk

et al. 2015

CUAJ

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Introduction: We evaluated the prognostic effects of hematologic parameters of preoperative leukocytosis and neutrophil-to-lymphocyte ratio (NLR) in patients who underwent radical cystectomy for bladder cancer. Methods: We retrospectively reviewed the medical records of 363 patients who underwent radical cystectomy for bladder cancer between January 1990 and June 2013. In total, 286 patients were included in the study. Age, gender, pathologic stage, lymph node involvement, preoperative hydronephrosis, histologic subtype, surgical margin status, and lymphovascular invasion were recorded for each patient. Univariate and multivariate analysis were performed to determine the prognostic value of the preoperative clinical and laboratory parameters on disease-specific survival (DSS). Additionally, the correlation between leukocytosis and other factors were evaluated. Results: According to the univariate analysis preoperative leukocytosis and NLR were detected as negative prognostic factors on DSS. Preoperative leukocytosis, NLR, stage, lymph node involvement, histologic subtype, grade and age were independent prognostic factors for DSS, on multivariate analysis. Patients with leukocytosis had higher stage, grade and lymphovascular invasion. Conclusions: Inexpensive, reproducible, and readily available peripheral blood count components of white blood cell count and NLR were independent prognostic factors, which can stratify DSS risks in bladder cancer patients who underwent radical cystectomy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer

Özcan

Telli

Öztürk

et al. 2015

CUAJ

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“…In this study we found that 57 Several studies reported the relationship between increased NLR and worse prognostic outcomes in various cancers including breast, colorectal and hepatocellular carcinomas, as well as, several urinary malignancies including prostate, bladder and renal cell carcinomas (RCC). [9][10][11][12][13][14] Proctor et al [15] performed a Scottish Cancer Registry review across 11 different malignancies, including 8759 patients, and noted a significantly increased risk of cancer-specific (HR=1.76) and overall mortality (HR=1.77) in patients with a preoperative NLR>5. Our results could not demonstrate the presence of any significant relationship between the NLR and PFS or CSS.…”

Section: Discussionmentioning

confidence: 99%

“…[22,23] Furthermore, a relative lymphocytopenia may reflect a lower count of CD4+ T-helper lymphocytes, resulting in a suboptimal lymphocytemediated immune response to malignancy. [13] Both of these factors may contribute to aggressive tumor biology, cancer progression, and poor prognosis. On the other hand, we did not find any significant association between the NLR and prognosis of TC.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors

Bolat

Aydoğdu

Polat

et al. 2017

Turkish Journal of Urology

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Objective: We investigated the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on germ cell testicular tumors (GCT). Material and methods:The data of 53 patients who underwent inguinal orchiectomy were analyzed retrospectively. NLR was calculated from the preoperative complete blood cell counts. Receiver operating characteristic (ROC) analysis was performed to find the threshold values for NLR. Correlations between cancer-specific survival (CSS) and progression-free survival (PFS) and NLR were evaluated. Results:The mean follow-up time was 23.55±18.06 months. The mean level of NLR was 3.08±1.81. Optimal threshold values of NLR was calculated as 3.55 for PFS (area under curve, AUC: 0.55) and 3.0 for CSS (AUC: 0.66). For patients with a NLR of <3.55 and NLR of ≥3.55, mean times-to-progression were 55.71 months (95% CI, 51.27-60.14) and 51.95 months (95% CI, 38.02-65.87, p= 0.152), respectively. As well as, for patients with a NLR of <3.0 and NLR of ≥3.0, mean times -to-cancer specific death were 54.72 months (95% CI, 49.05-60.38) and 49.43 months (95% CI, 37.64-61.22, p= 0.119), respectively. Conclusion:Preoperative NLR is not a useful tool to predict the prognosis of patients with GCT.

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Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle‐invasive bladder cancer after surgery

et al. 2023

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Objectives To build a nomogram prediction model, assess its predictive ability, and perform a survival decision analysis on patients with muscle‐invasive bladder cancer (MIBC) to study risk factors affecting overall survival (OS). Methods A retrospective analysis was performed on the clinical information of 262 patients with MIBC who underwent radical cystectomy (RC) at the Urology Department of the Second Affiliated Hospital of Kunming Medical University between July 2015 and August 2021. The final model variables that were included were chosen using single‐factor stepwise Cox regression, optimal subset regression, and LASSO regression + cross‐validation with the minimum AIC value. The next step was to do a multivariate Cox regression analysis. The establishment of a nomogram model by fitting and the screening out of independent risk factors impacting the survival of patients with MIBC having radical resection. Receiver Activity Characteristic curves, C‐index, and a calibration plot evaluated the prediction accuracy, validity, and clinical benefit of the model. The 1‐, 3‐, and 5‐year survival rates were then computed for each risk factor using a Kaplan–Meier survival analysis. Results 262 eligible patients in total were enrolled. With a median follow‐up of 32 months, the follow‐up period ranged from 2 to 83 months. 171 cases (65.27%) survived while 91 cases (34.73%) perished. Age (HR = 1.06 [1.04; 1.08], p = 0.001), preoperative hydronephrosis (HR = 0.69 [0.46, 1.05], p = 0.087), T stage (HR = 2.06 [1.09, 3.93], p = 0.027), lymphovascular invasion (LVI, HR = 1.73 [1.12, 2.67], p = 0.013), prognostic nutritional index (PNI, HR = 1.70 [1.09, 2.63], p = 0.018), and neutrophil‐to‐lymphocyte ratio (NLR, HR = 0.52 [0.29, 0.93)], p = 0.026) were independent risk factor for the survival of bladder cancer patients. Create a nomogram based on the aforementioned findings, and then draw the 1‐year, 3‐year, and 5‐year OS receiver operating characteristic curves by the nomogram. The AUC values were 0.811 (95% CI [0.752, 0.869]), 0.814 (95% CI [0.755, 0.873]), and 0.787 (95% CI [0.708, 0.865]), respectively, and the calibration plot matched the predicted value well. The 1‐year, 3‐year, and 5‐year decision curve analyses were higher than the ALL line and None line at threshold values of >5%, 5%–70%, and 20%–70% indicating that the model has good clinical applicability. The calibration plot for the Bootstrap 1000‐time resampled validation model was similar to the actual value. Patients with preoperative combination hydronephrosis, higher T‐stage, combined LVI, low PNI, and high NLR had worse survival, according to Kaplan–Meier survival analysis for each variable. Conclusions This study might conclude that PNI and NLR were separate risk factors that affect a patient's OS after RC for MIBC. The prognosis of bladder cancer may be predicted by PNI and NLR, but additional confirmation in randomized controlled trials is required.

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Pretreatment Neutrophil-to-Lymphocyte Ratio Is Associated with Advanced Pathologic Tumor Stage and Increased Cancer-specific Mortality Among Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy

Cited by 177 publications

References 27 publications

The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer

The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer

Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors

Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle‐invasive bladder cancer after surgery

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