ABSTRACT
Introduction
There is a persistent lack of validated biomarkers that identify patients most likely
to benefit from neoadjuvant chemotherapy (NAC) in urothelial carcinoma of the bladder
(UCB). Therefore, the purpose of this study was to investigate the predictive and
prognostic impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in UCB
patients treated with NAC and radical cystectomy (RC).
Patients and Methods
We conducted a retrospective analysis of an international-multicenter database comprising
404 UCB patients staged cT2-4N0-3M0. The cohort was split into low and high NLR using
an optimal cutoff value determined by maximizing Youden's index. Logistic and Cox
regression analyses were performed with respect to several clinical endpoints. The
discriminatory ability of the models and the additive discriminatory value of NLR
was assessed by calculating the area under receiver operating characteristics curves,
C-Index, and decision curve analysis (DCA).
Results
169 patients (41.8%) had a high NLR, which was associated with a decreased probability
of complete response (CR, OR: 0.24 [95%CI 0.13-0.42], p<0.001) and/or partial response
(PR, OR: 0.33 [95%CI 0.21-0.49], p<0.001). Adding the NLR to predictive reference
models significantly improved their accuracy for the prediction of both CR and PR.
A high NLR was associated with poor survival outcomes in the pretreatment setting,
however, it didn't meaningfully change the C-Index based on the model.
Conclusion
We confirmed that an elevated NLR is an independent and clinically significant predictor
of response to NAC and adverse pathological features in UCB treated with NAC plus
RC. The accuracy of this biomarker in the age of immunotherapy warrants further evaluation.
MicroAbstract
Validated biomarkers to predict response to preoperative chemotherapy in bladder cancer
are lacking. We investigated the predictive/prognostic impact of the pretreatment
neutrophil-lymphocyte ratio (NLR) in 404 bladder cancer patients treated with preoperative
chemotherapy and radical surgery. A high NLR was associated with a decreased probability
of complete and/or partial response to chemotherapy. NLR may risk-stratify patients
prior to radical surgery.
Keywords
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Article info
Publication history
Accepted:
January 21,
2023
Received in revised form:
January 18,
2023
Received:
September 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
