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.
Keywords
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Article info
Publication history
Published online: July 05, 2018
Accepted:
July 3,
2018
Received in revised form:
June 15,
2018
Received:
March 9,
2018
Footnotes
M.D.V. and M.F. contributed equally to this work as first authors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
