Abstract
Background
Currently, stratification of patients with bladder cancer (BC) mainly relies on histopathologic
and clinical staging. Furthermore, inflammation plays an important role in the pathogenesis
of BC. With the preoperative platelet-to-leukocyte ratio (PLR), we introduce a novel
prognostic marker based on routine hematologic values in patients undergoing radical
cystectomy (RC).
Patients and Methods
In our cohort of 665 patients undergoing RC (2004-2015) for urothelial carcinoma of
the bladder (UCB), we analyzed a variety of preoperative hematologic parameters. We
investigated the effect of thrombocytosis, leukocytosis, and the PLR on the oncologic
outcomes, including cancer-specific survival (CSS), progression-free survival (PFS),
and overall survival (OS). Both univariate (log-rank test) and multivariate (Cox regression)
analysis were performed. The prevalence of thrombocytosis and leukocytosis and differences
in the PLR was assessed using the Mann-Whitney U test. The cutoff levels for leukocytosis, thrombocytosis, and the PLR were defined
using receiver operating characteristic curve analysis, with the 5-year CSS as the
binary classifier.
Results
A PLR of ≤ 28 (CSS, P = .033; OS, P = .029) and leukocytosis (CSS, P = .01; OS, P = .001; PFS, P = .003) were significantly associated with adverse oncologic outcomes using the log-rank
test. On multivariate regression analysis, the PLR (CSS, P = .022; OS, P = .025) remained a significant prognostic marker among the standard staging variables
and hemoglobin level. Advanced BC disease was significantly more prevalent in the
patient subgroup with a low PLR (pT2-pT4, 35%; vs. pT ≤ 1, 24%; P = .006) and leukocytosis (pT2-pT4, 46%; vs. pT ≤ 1, 30%; P < .001; pN+, 49%; vs. pN0, 39%; P < .047).
Conclusion
To the best of our knowledge, the present study is the first report of the preoperative
PLR as a prognostic factor in patients undergoing RC for UCB. Compared with other
inflammatory markers in BC, the PLR can be assessed without additional effort. External
validation and its combination with other parameters might improve current prognostication
systems for UCB.
Keywords
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Article info
Publication history
Published online: May 09, 2017
Accepted:
May 1,
2017
Received in revised form:
April 25,
2017
Received:
January 21,
2017
Footnotes
G.B.S. and T.G. contributed equally to this work as first authors.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
