Preoperative Neutrophil/Lymphocyte Ratio Predicts Overall Survival and Extravesical Disease in Patients Undergoing Radical Cystectomy
ABSTRACT Objectives: To evaluate if hematologic parameters and inflammatory markers, could predict extravesical tumor and overall survival following radical cystectomy for patients with recurrent high grade T1 or muscle invasive bladder cancer. Patients and Methods: A total of 68 consecutive cases of radical cystectomy performed with curative intent at our institution between April 2005 and October 2011 with preoperative hematologic parameters are included in this analysis. We evaluated preoperative characteristics with uni and multivariate cox proportion hazard ratios to assist in risk stratification for overall survival. Relative risk ratios (RR) and 95% confidence intervals (CI) were created. We also identified factors associated with extravesical tumor extension with logistic regression analysis. Results: Median overall survival was in the total cohort was 25 months. (95% CI 13-61) In multivariate analysis, neutrophil/lymphocyte ratio < 2.5 (RR 2.49; 95% CI 1.14 - 6.09) hypoalbuminemia (RR 4.96; 95% CI 2.18 - 11.67), pT3/4 (RR 7.97, 95% CI 3.16-24.83) and lymph node positive disease predicted (RR 2.62, 95% CI 1.26-5.46) overall survival. These were statistically significant for cancer specific survival as well. Both elevated neutrophil/lymphocyte ratio (RR 3.18, 95% CI 1.09 - 9.79) and hypoalbuminemia (RR 3.72, 95% CI 1.12 - 15.00) were associated with risk for extravesical disease. Conclusions: Serum neutrophil/lymphocyte ratio and hypoalbuminemia predict overall and cancer specific survival in patients undergoing radical cystectomy for muscle invasive bladder cancer. These parameters also predict risk for extravesical disease. These could be combined with other established preoperative parameters to improve risk stratification and preoperative counseling.
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- "One of the other studies chose 2 . 5 as their cutoff point for consistency with Gondo et al ( 2012 ) ( Krane et al , 2013 ) , whereas the third study did not elaborate on the rationale for their cutoff point value ( Demirtas et al , 2013 ) . We used time - dependent ROC curves to determine the optimal cutoff point for NLR . "
ABSTRACT: Background: An elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor outcome in various tumours. Its prognostic utility in patients with urothelial carcinoma of the bladder (UCB) undergoing radical cystectomy (RC) is yet to be fully elucidated. Methods: A cohort of patients undergoing RC for UCB in a tertiary referral centre between 1992 and 2012 was analysed. Neutrophil-to-lymphocyte ratio was computed using complete blood counts performed pre-RC, or before neo-adjuvant chemotherapy where applicable. Time-dependent receiver operating characteristic curves were used to determine the optimal cutoff point for predicting recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). The predictive ability of NLR was assessed using Kaplan–Meier analyses and multivariable Cox proportional hazards models. The likelihood-ratio test was used to determine whether multivariable models were improved by including NLR. Results: The cohort included 424 patients followed for a median of 58.4 months. An NLR of 3 was determined as the optimal cutoff value. Patients with an NLRX3.0 had significantly worse survival outcomes (5y-RFS: 53% vs 64%, log-rank P 1⁄4 0.013; 5y-CSS: 57% vs 75%, log-rank Po0.001; 5y-OS: 43% vs 64%, log-rank Po0.001). After adjusting for disease-specific predictors, an NLR X3.0 was significantly associated with worse RFS (HR 1⁄4 1.49; 95% CI 1⁄4 1.12–2.0, P 1⁄4 0.007), CSS (HR 1⁄4 1.88; 95% CI 1⁄4 1.39–2.54, Po0.001) and OS (average HR 1⁄4 1.67; 95% CI 1⁄4 1.17–2.39, P 1⁄4 0.005). The likelihood-ratio test confirmed that prognostic models were improved by including NLR. Conclusions: Neutrophil-to-lymphocyte ratio is an inexpensive prognostic biomarker for patients undergoing RC for UCB. It offers pre-treatment prognostic value in addition to established prognosticators and may be helpful in guiding treatment decisions.British Journal of Cancer 06/2014; 111(3). DOI:10.1038/bjc.2014.305 · 4.82 Impact Factor
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ABSTRACT: To determine whether the pretreatment neutrophil-to-lymphocyte ratio (NLR), a measure of systemic inflammatory response, is associated with overall survival (OS) in men receiving chemotherapy with docetaxel for metastatic castration-resistant prostate cancer (mCRPC). Records from 238 consecutive patients who were treated with first-line docetaxel-containing chemotherapy for mCRPC at a single high-volume centre from 1998 to 2010 (and who had adequate information to enable calculation of NLR) were reviewed. Univariable and multivariable Cox regression models were used to predict OS after chemotherapy initiation. In univariable analyses, the NLR as a discrete variable (optimal threshold 3.0) was significantly associated with OS (P = 0.001). In multivariable analyses, a lower NLR (≤3.0) was associated with lower risk of all-cause mortality (P = 0.002). In Kaplan-Meier analysis, the median OS was higher (18.3 vs 14.4 months) in patients that did not have an elevated NLR than in those with an elevated NLR (log-rank; P < 0.001). Men who were treated with first-line docetaxel for mCRPC who had a low pretreatment NLR (≤3.0) had significantly longer OS. NLR may be a potentially useful clinical marker of systemic inflammatory response in predicting OS in men with mCRPC who receive docetaxel and may be helpful to stratify patients for clinical trials. These findings derived from a retrospective analysis need to be validated in larger populations in prospective studies, and in the context of different therapies.BJU International 10/2013; 114(6B). DOI:10.1111/bju.12531 · 3.13 Impact Factor
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ABSTRACT: There is increasing evidence to suggest that cancer-associated inflammation is associated with poorer long-term outcomes. Various markers have been studied over the past decade in an attempt to improve selection of patients for surgery. This meta-analysis explored the association between the neutrophil-lymphocyte ratio and prognosis following curative-intent surgery for solid tumours. Studies were identified from US National Library of Medicine (Medline) and the Exerpta Medica database (EBASE) performed in March 2013. A systematic review and meta-analysis were performed to generate combined hazard ratios for overall survival (OS) and disease-free survival (DFS). Forty-nine studies containing 14282 patients were included. Elevated NLR was associated with poorer overall survival [HR: 1.92, 95% CI (1.64-2.24)] (p < 0.001) and disease-free survival [HR: 1.99, 95% CI (1.80-2.20)] (p < 0.001). Significant heterogeneity was found with an I(2) of 77% and 97% for OS and DFS respectively. Subgroup analyses demonstrated that gastro-intestinal malignancies; mainly gastric [HR: 1.97, 95% CI (1.41-2.76)], colorectal [HR: 1.65, 95% CI (1.21-2.26)] and oesophageal [HR: 1.48, 95% CI (0.91-2.42)] cancers were predictive of OS (I(2) = 54.3%). A separate analysis for studies using an NLR cutoff of 5 demonstrated significantly poorer outcomes [HR: 2.18, 95% CI (1.74-2.73)] (p = 0.002) with less heterogeneity (I(2) = 58%). Elevated NLR correlates with poorer prognosis. It potentially represents a simple, robust and reliable measure that may be useful in identifying high-risk groups who could benefit from adjuvant therapy.Surgical Oncology 12/2013; 23(1). DOI:10.1016/j.suronc.2013.12.001 · 2.37 Impact Factor