Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer
Yu Guang Tan, Ernest Eu, Weber Lau Kam On, Hong Hong Huang
Department of Urology, Singapore General Hospital, Singapore
Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer
Yu Guang Tan, Ernest Eu, Weber Lau Kam On, Hong Hong Huang
Department of Urology, Singapore General Hospital, Singapore
摘要 Objective: To determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer. Methods: We retrospectively reviewed 84 patients undergoing radical cystectomy (RC) for UCB from January 2002 to June 2012. NLR was computed (median:5 days) prior to surgery. No patients received neoadjuvant chemotherapy. NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained, with a statistical receiver operating characteristics of 0.74. Kaplan-Meier curves, multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes. Results: The median follow-up period was 30.1 months (range:3.2-161.7) owing to high recurrence rate and subsequent mortalities, compared to the median 64.7 months in patients alive at the end of study period. NLR ≥ 2.7 was associated with worse survival outcomes (5-year disease-specific survival:22% vs 58%, p=0.017, 95%CI:1.193-6.009; 5-year overall survival:23% vs 60%,p=0.008, 95%CI:1.322-6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate (p=0.007, HR=6.999, 95% CI:1.712-28.606), higher T staging (p=0.021, HR=3.479, 95%CI:1.212-9.990) and lymph node involvement (p=0.009, HR=4.534, 95%CI:1.465-14.034).
Abstract: Objective: To determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer. Methods: We retrospectively reviewed 84 patients undergoing radical cystectomy (RC) for UCB from January 2002 to June 2012. NLR was computed (median:5 days) prior to surgery. No patients received neoadjuvant chemotherapy. NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained, with a statistical receiver operating characteristics of 0.74. Kaplan-Meier curves, multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes. Results: The median follow-up period was 30.1 months (range:3.2-161.7) owing to high recurrence rate and subsequent mortalities, compared to the median 64.7 months in patients alive at the end of study period. NLR ≥ 2.7 was associated with worse survival outcomes (5-year disease-specific survival:22% vs 58%, p=0.017, 95%CI:1.193-6.009; 5-year overall survival:23% vs 60%,p=0.008, 95%CI:1.322-6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate (p=0.007, HR=6.999, 95% CI:1.712-28.606), higher T staging (p=0.021, HR=3.479, 95%CI:1.212-9.990) and lymph node involvement (p=0.009, HR=4.534, 95%CI:1.465-14.034). Conclusion: This study suggests that NLR can be an inexpensive novel factor for patients risk stratification pre-operatively. This improves patient counseling and identifies patients who may benefit from multimodal treatment.
Yu Guang Tan, Ernest Eu, Weber Lau Kam On, Hong Hong Huang. Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer[J]. Asian Journal of Urology, 2017, 4(4): 239-246.
Yu Guang Tan, Ernest Eu, Weber Lau Kam On, Hong Hong Huang. Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer. Asian Journal of Urology, 2017, 4(4): 239-246.
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