Data of 397 UTUC patients, who underwent radical nephroureterectomy (RNU) and had no history of neoadjuvant chemotherapy between 1999 and 2012, were retrospectively reviewed. The cut-off point of NLR was 3. Pre- and postoperative NLR as dichotomized (normal: <3 and elevated: >3) was analyzed in reference to survival outcomes. The estimation and comparison of overall survival (OS) and cancer-specific survival (CSS) rates were plotted with the Kaplan-Meier method and log-rank test. The impact of NLR on survival outcomes was assessed using univariable and multivariable Cox proportional hazard models.
Patients with postoperative elevated NLR showed significantly worse 5-year OS (45.9% vs. 70.7%, log-rank p <0.001) and CSS (58.9% vs. 77.0%, log-rank p <0.001) rates. These survival differences were also similar in association with preoperative NLR. When performing survival analysis in subgroups, the significant survival differences according to postoperative NLR was found only in patients with high grade tumor and negative surgical margin (all log-rank p<0.05). On multivariable analysis adjusting other well-known prognostic factors, such as stage, grade, lymphovascular invasion, and surgical margin, increased postoperative NLR was significantly associated with worse OS (hazard ratio (HR) 1.15; 95% confidence interval 1.04-1.27, p=0.007) and CSS (HR 1.13; 95% CI 1.01-127, p=0.045).
This study suggests that NLR in the postoperative setting as well as in the preoperative setting may be used as an inexpensive prognostic biomarker predicting survival outcomes in UTUC patients treated with RNU.
Presented by: Jeong Woo Lee
Affiliation: Dongguk University Ilsan Medical Center, Goyang, South Korea
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal