Ilaria Lucca1, Patrice Jichlinski2, Shahrokh F Shariat3, Morgan Rouprêt4, Malte Rieken5, Luis A Kluth6, Michael Rink6, Romain Mathieu7, Aurelie Mbeutcha8, Agnes Maj-Hes8, Harun Fajkovic8, Alberto Briganti9, Christian Seitz8, Pierre I Karakiewicz10, Michela de Martino8, Yair Lotan11, Marko Babjuk12, Tobias Klatte8. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 2. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. Electronic address: sfshariat@gmail.com. 4. Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, University Paris 6, Paris, France. 5. Department of Urology, University Hospital Basel, Basel, Switzerland. 6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France. 8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 9. Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. 10. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QB, Canada. 11. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 12. Department of Urology, Hospital Motol, Second Faculty of Medicine, Prague, Czech Republic.
Abstract
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). OBJECTIVE: To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. DESIGN, SETTING, AND PARTICIPANTS: The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. RESULTS AND LIMITATIONS: A high NLR (≥2.7) was associated with advanced pathological tumor stages (p<0.001), lymph node involvement (p<0.001), lymphovascular invasion (p=0.008), and positive soft0tissue surgical margins (p=0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01-1.22; p=0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07-1.37, p=0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01-1.92) for OS and 1.51 (95% CI 1.17-1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. CONCLUSION: In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. PATIENT SUMMARY: We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). OBJECTIVE: To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. DESIGN, SETTING, AND PARTICIPANTS: The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. RESULTS AND LIMITATIONS: A high NLR (≥2.7) was associated with advanced pathological tumor stages (p<0.001), lymph node involvement (p<0.001), lymphovascular invasion (p=0.008), and positive soft0tissue surgical margins (p=0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01-1.22; p=0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07-1.37, p=0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01-1.92) for OS and 1.51 (95% CI 1.17-1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. CONCLUSION: In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. PATIENT SUMMARY: We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.
Authors: Matteo Ferro; Giuseppe Di Lorenzo; Carlo Buonerba; Giuseppe Lucarelli; Giorgio Ivan Russo; Francesco Cantiello; Abdal Rahman Abu Farhan; Savino Di Stasi; Gennaro Musi; Rodolfo Hurle; Serretta Vincenzo; Gian Maria Busetto; Ettore De Berardinis; Sisto Perdonà; Marco Borghesi; Riccardo Schiavina; Gilberto L Almeida; Pierluigi Bove; Estevao Lima; Giovanni Grimaldi; Deliu Victor Matei; Francesco Alessandro Mistretta; Nicolae Crisan; Daniela Terracciano; Verze Paolo; Michele Battaglia; Giorgio Guazzoni; Riccardo Autorino; Giuseppe Morgia; Rocco Damiano; Matteo Muto; Roberto La Rocca; Vincenzo Mirone; Ottavio de Cobelli; Mihai Dorin Vartolomei Journal: J Cancer Date: 2018-10-20 Impact factor: 4.207
Authors: Andrea Mari; Gianluca Muto; Fabrizio Di Maida; Riccardo Tellini; Riccardo Bossa; Claudio Bisegna; Riccardo Campi; Andrea Cocci; Lorenzo Viola; Antonio Grosso; Sabino Scelzi; Alberto Lapini; Marco Carini; Andrea Minervini Journal: Arab J Urol Date: 2020-08-26