Aaron Potretzke1, Luke Hillman2, Kelvin Wong3, Fangfang Shi3, Ryan Brower2, Stephanie Mai2, Jeremy P Cetnar4, Edwin Jason Abel5, Tracy M Downs5. 1. Department of Urology, University of Wisconsin, Madison, WI. Electronic address: apotretzke@uwhealth.org. 2. University of Wisconsin School of Medicine and Public Health, Madison, WI. 3. Department of Urology, University of Wisconsin, Madison, WI. 4. University of Wisconsin Carbone Cancer Center, Madison, WI. 5. Department of Urology, University of Wisconsin, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI.
Abstract
OBJECTIVE: To evaluate the ability of preoperative neutrophil-lymphocyte ratio (NLR) to predict pathologic upstaging and nonorgan-confined (NOC) (≥pT3) disease. METHODS AND MATERIALS: After institutional review board approval, the records of consecutive patients undergoing radical cystectomy (RC) for urothelial carcinoma from 2002 to 2012 at the University of Wisconsin Hospital were reviewed. A total of 102 patients with NLR within 100 days of surgery were eligible for analysis. The primary outcome was difference in stage from preoperative assessment to time of RC. Differences in preoperative NLR between groups were evaluated with an unequal variance t test. A univariate analysis assessed whether NLR, preoperative stage, grade, associated lymphovascular invasion, preoperative hydronephrosis, gender, previous pelvic radiotherapy, previous intravesical bladder cancer treatments, or nodal stage were related to upstaging. Multivariate analyses were performed to evaluate the relationship of NLR to upstaging and relative organ-confined (≤pT2) and NOC disease. RESULTS: Of 390 consecutive patients undergoing RC, 102 patients met study criteria. Overall, 55 (53.9%) patients were upstaged, 25 (25.5%) were unchanged, and 21 (20.6%) were downstaged. Fifty-one patients (50%) were upstaged to more advanced disease (≥pT3). NLR and preoperative hydronephrosis were significantly related to pathologic tumor staging. NLR, preoperative hydronephrosis, and preoperative tumor stage were significantly related to upstaging to NOC disease. Patients who were upstaged to≥pT3 demonstrated statistically significant greater NLRs (4.33±0.87) compared with patients who remained at≤pT2 stage (2.66±0.29) (P<0.001). CONCLUSIONS: Preoperative NLR is a simple measurement that can be used to identify high-risk patients who may be upstaged at the time of RC and may benefit from neoadjuvant chemotherapy.
OBJECTIVE: To evaluate the ability of preoperative neutrophil-lymphocyte ratio (NLR) to predict pathologic upstaging and nonorgan-confined (NOC) (≥pT3) disease. METHODS AND MATERIALS: After institutional review board approval, the records of consecutive patients undergoing radical cystectomy (RC) for urothelial carcinoma from 2002 to 2012 at the University of Wisconsin Hospital were reviewed. A total of 102 patients with NLR within 100 days of surgery were eligible for analysis. The primary outcome was difference in stage from preoperative assessment to time of RC. Differences in preoperative NLR between groups were evaluated with an unequal variance t test. A univariate analysis assessed whether NLR, preoperative stage, grade, associated lymphovascular invasion, preoperative hydronephrosis, gender, previous pelvic radiotherapy, previous intravesical bladder cancer treatments, or nodal stage were related to upstaging. Multivariate analyses were performed to evaluate the relationship of NLR to upstaging and relative organ-confined (≤pT2) and NOC disease. RESULTS: Of 390 consecutive patients undergoing RC, 102 patients met study criteria. Overall, 55 (53.9%) patients were upstaged, 25 (25.5%) were unchanged, and 21 (20.6%) were downstaged. Fifty-one patients (50%) were upstaged to more advanced disease (≥pT3). NLR and preoperative hydronephrosis were significantly related to pathologic tumor staging. NLR, preoperative hydronephrosis, and preoperative tumor stage were significantly related to upstaging to NOC disease. Patients who were upstaged to≥pT3 demonstrated statistically significant greater NLRs (4.33±0.87) compared with patients who remained at≤pT2 stage (2.66±0.29) (P<0.001). CONCLUSIONS: Preoperative NLR is a simple measurement that can be used to identify high-risk patients who may be upstaged at the time of RC and may benefit from neoadjuvant chemotherapy.
Authors: Eric Ojerholm; Andrew Smith; Wei-Ting Hwang; Brian C Baumann; Kai N Tucker; Seth P Lerner; Ronac Mamtani; Ben Boursi; John P Christodouleas Journal: Cancer Date: 2016-10-27 Impact factor: 6.860
Authors: Bimal Bhindi; Thomas Hermanns; Yanliang Wei; Julie Yu; Patrick O Richard; Marian S Wettstein; Arnoud Templeton; Kathy Li; Srikala S Sridhar; Michael A S Jewett; Neil E Fleshner; Alexandre R Zlotta; Girish S Kulkarni Journal: Br J Cancer Date: 2015-12-10 Impact factor: 7.640