Aurélie Mbeutcha1, Shahrokh F Shariat2, Malte Rieken3, Michael Rink4, Evanguelos Xylinas5, Christian Seitz6, Ilaria Lucca7, Romain Mathieu8, Morgan Rouprêt9, Alberto Briganti10, Pierre I Karakiewicz11, Tobias Klatte6. 1. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Nice Sophia-Antipolis, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France. 2. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: sfshariat@gmail.com. 3. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University Hospital Basel, Basel, Switzerland. 4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France. 6. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 7. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 8. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France. 9. Department of Urology, Pitié- Salpétrière, APHP, University Paris VI, Paris, France. 10. Department of Urology, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy. 11. Department of Urology, University of Montreal, Montreal, Quebec, Canada.
Abstract
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non-muscle-invasive bladder cancer (NMIBC) have not been well studied yet. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months. RESULTS: In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%). CONCLUSION: In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non-muscle-invasive bladder cancer (NMIBC) have not been well studied yet. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months. RESULTS: In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%). CONCLUSION: In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.
Authors: Ellen Westhoff; J Alfred Witjes; Neil E Fleshner; Seth P Lerner; Shahrokh F Shariat; Gunnar Steineck; Ellen Kampman; Lambertus A Kiemeney; Alina Vrieling Journal: Bladder Cancer Date: 2018-01-20