Francesco Cantiello1, Giorgio I Russo2, Mihai Dorin Vartolomei3, Abdal Rahman Abu Farhan1, Daniela Terracciano4, Gennaro Musi5, Giuseppe Lucarelli6, Savino M Di Stasi7, Rodolfo Hurle8, Vincenzo Serretta9, Gian Maria Busetto10, Chiara Scafuro1, Sisto Perdonà11, Marco Borghesi12, Riccardo Schiavina12, Antonio Cioffi5, Ettore De Berardinis13, Gilberto L Almeida14, Pierluigi Bove8, Estevao Lima15, Giuseppe Ucciero1, Deliu Victor Matei16, Nicolae Crisan17, Paolo Verze18, Michele Battaglia7, Giorgio Guazzoni9, Riccardo Autorino19, Giuseppe Morgia20, Rocco Damiano1, Ottavio de Cobelli5, Vincenzo Mirone18, Shahrokh F Shariat21, Matteo Ferro5. 1. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. 2. Department of Urology, University of Catania, Catania, Italy. Electronic address: giorgioivan1987@gmail.com. 3. 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. 4. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy. 5. Division of Urology, European Institute of Oncology, Milan, Italy. 6. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy. 7. Department of Surgery and Experimental Medicine, University Tor Vergata, Rome, Italy. 8. Department of Urology, Humanitas Hospital, Milan, Italy. 9. Department of Urology, University of Palermo, Palermo, Italy. 10. Department of Urology, Sapienza University of Rome, Rome, Italy. 11. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Naples, Italy. 12. Department of Urology, University of Bologna, Bologna, Italy. 13. Department of Gynecological-Obstetrics Sciences and Urological Sciences, Sapienza Rome University Policlinico Umberto I, Rome, Italy. 14. Department of Urology, University of Vale do Itajaí, Itajaí, Brazil. 15. Department of CUF Urology and Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. 16. Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania. 17. Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania. 18. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy. 19. Division of Urology, Virginia Commonwealth University, Richmond, VA, USA. 20. Department of Urology, University of Catania, Catania, Italy. 21. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Abstract
BACKGROUND: Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC). OBJECTIVE: To evaluate the prognostic role of the combination of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC). DESIGN, SETTING, AND PARTICIPANTS: A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo. INTERVENTION: TURBT with intravesical chemotherapy or immunotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox regression analysis was performed to identify factors predictive of recurrence, progression, cancer-specific mortality, and overall mortality. A systemic inflammatory marker (SIM) score was calculated based on cutoffs for NLR, PLR, and LMR. RESULTS AND LIMITATIONS: The 48-mo recurrence-free survival was 80.8%, 47.35%, 20.67%, and 17.06% for patients with an SIM score of 0, 1, 2, and 3, respectively (p<0.01, log-rank test) while the corresponding 48-mo progression free-survival was 92.0%, 75.67%, 72.85%, and 63.1% (p<0.01, log-rank test). SIM scores of 1, 2, and 3 were associated with recurrence (hazard ratio [HR] 3.73, 7.06, and 7.88) and progression (HR 3.15, 4.41, and 5.83). Limitations include the lack of external validation and comparison to other clinical risk models. CONCLUSIONS: Patients with high-grade T1 stage NMIBC with high SIM scores have worse oncologic outcomes in terms of recurrence and progression. Further studies should be conducted to stratify patients according to SIM scores to identify individuals who might benefit from early cystectomy. PATIENT SUMMARY: In this study, we defined a risk score (the SIM score) based on the measurement of routine systemic inflammatory markers. This score can identify patients with high-grade bladder cancer not invading the muscular layer who are more likely to suffer from tumor recurrence and progression. Therefore, the score could be used to select patients who might benefit from early bladder removal.
BACKGROUND: Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC). OBJECTIVE: To evaluate the prognostic role of the combination of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC). DESIGN, SETTING, AND PARTICIPANTS: A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo. INTERVENTION: TURBT with intravesical chemotherapy or immunotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox regression analysis was performed to identify factors predictive of recurrence, progression, cancer-specific mortality, and overall mortality. A systemic inflammatory marker (SIM) score was calculated based on cutoffs for NLR, PLR, and LMR. RESULTS AND LIMITATIONS: The 48-mo recurrence-free survival was 80.8%, 47.35%, 20.67%, and 17.06% for patients with an SIM score of 0, 1, 2, and 3, respectively (p<0.01, log-rank test) while the corresponding 48-mo progression free-survival was 92.0%, 75.67%, 72.85%, and 63.1% (p<0.01, log-rank test). SIM scores of 1, 2, and 3 were associated with recurrence (hazard ratio [HR] 3.73, 7.06, and 7.88) and progression (HR 3.15, 4.41, and 5.83). Limitations include the lack of external validation and comparison to other clinical risk models. CONCLUSIONS:Patients with high-grade T1 stage NMIBC with high SIM scores have worse oncologic outcomes in terms of recurrence and progression. Further studies should be conducted to stratify patients according to SIM scores to identify individuals who might benefit from early cystectomy. PATIENT SUMMARY: In this study, we defined a risk score (the SIM score) based on the measurement of routine systemic inflammatory markers. This score can identify patients with high-grade bladder cancer not invading the muscular layer who are more likely to suffer from tumor recurrence and progression. Therefore, the score could be used to select patients who might benefit from early bladder removal.