Mihai Dorin Vartolomei1, Matteo Ferro2, Francesco Cantiello3, Giuseppe Lucarelli4, Savino Di Stasi5, Rodolfo Hurle6, Giorgio Guazzoni7, Gian Maria Busetto8, Ettore De Berardinis8, Rocco Damiano3, Sisto Perdona9, Paolo Verze10, Roberto La Rocca10, Marco Borghesi11, Riccardo Schiavina11, Eugenio Brunocilla11, Gilberto L Almeida12, Pierluigi Bove13, Estevao Lima14, Giovanni Grimaldi14, Riccardo Autorino15, Nicolae Crisan16, Abdal Rahman Abu Farhan3, Michele Battaglia4, Vincenzo Serretta17, Giorgio Ivan Russo18, Giuseppe Morgia18, Daniela Terracciano19, Gennaro Musi20, Ottavio de Cobelli21, Vincenzo Mirone10, Shahrokh F Shariat22. 1. Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania. 2. Division of Urology, European Institute of Oncology, Milan, Italy. Electronic address: matteo.ferro@ieo.it. 3. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. 4. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy. 5. Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy. 6. Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy. 7. Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy; Humanitas University, Department of Biomedical Science, Rozzano (Milan), Italy. 8. Department of Urology, Sapienza University of Rome, Rome, Italy. 9. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy. 10. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy. 11. Department of Urology, University of Bologna, Bologna, Italy. 12. Departamento de Urologia, University of Vale do Itajaí, Itajaí, Brasil. 13. Division of Urology, Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University of Rome, Rome, Italy. 14. Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. 15. Division of Urology, Virginia Commonwealth University, Richmond, VA. 16. Department of Urology, University of Medicine and Pharmacy "Iuliu Haţeganu," Cluj-Napoca, Romania. 17. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy. 18. Department of Urology, University of Catania, Catania, Italy. 19. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy. 20. Division of Urology, European Institute of Oncology, Milan, Italy. 21. Division of Urology, European Institute of Oncology, Milan, Italy; Università degli Studi di Milano, Milan, Italy. 22. Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.
Abstract
INTRODUCTION: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS). RESULTS: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%). CONCLUSIONS: Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.
INTRODUCTION: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS). RESULTS: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%). CONCLUSIONS: Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.
Authors: M Ferro; G Di Lorenzo; M D Vartolomei; D Bruzzese; F Cantiello; G Lucarelli; G Musi; S Di Stasi; R Hurle; G Guazzoni; G M Busetto; A Gabriele; F Del Giudice; R Damiano; F Perri; S Perdona; P Verze; M Borghesi; R Schiavina; G L Almeida; P Bove; E Lima; R Autorino; N Crisan; A R Abu Farhan; M Battaglia; G I Russo; Vincenzo Ieluzzi; G Morgia; P De Placido; D Terracciano; A Cimmino; L Scafuri; V Mirone; O De Cobelli; S Shariat; Guru Sonpavde; C Buonerba Journal: World J Urol Date: 2019-04-16 Impact factor: 4.226
Authors: Matteo Ferro; Dragoş-Florin Babă; Ottavio de Cobelli; Gennaro Musi; Giuseppe Lucarelli; Daniela Terracciano; Angelo Porreca; Gian Maria Busetto; Francesco Del Giudice; Francesco Soria; Paolo Gontero; Francesco Cantiello; Rocco Damiano; Papalia Rocco; Roberto Mario Scarpa; Abdal Rahman Abu Farhan; Riccardo Autorino; Antonio Brescia; Michele Marchioni; Andrea Mari; Andrea Minervini; Nicola Longo; Francesco Chiancone; Sisto Perdona'; Biagio Barone; Pietro De Placido; Michele Catellani; Danilo Bottero; Pasquale Ditonno; Michele Battaglia; Stefania Zamboni; Alessandro Antonelli; Francesco Greco; Giorgio Ivan Russo; Salvatore Smelzo; Rodolfo Hurle; Nicolae Crisan; Matteo Manfredi; Francesco Porpiglia; Felice Crocetto; Carlo Buonerba; Alina Danilesco; Mihai Dorin Vartolomei Journal: Future Sci OA Date: 2021-04-20