Utility of preoperative Neutrophil / Lymphocyte ratio (NLR) as a new objective prognostic tool in endoscopically treated upper tract urothelial carcinoma. A retrospective evaluation.

Introduction This exploratory retrospective analysis examined any potential prognostic role of pre-operative NLR for progression free survival (PFS) and time to endoscopically verified upper tract or bladder recurrence free survival (RFS), in upper tract urothelial cancer (UTUC) patients selected for endoscopic treatment with subsequent endo-surveillance. Patients and Methods Eligibility criteria were natural orifice endoscopically retrogradely treated low-risk and imperative UTUC patients treated between 2005-2019, with biopsy confirmed diagnosis and 12 months minimum follow-up. For PFS, optimal NLR cut-off value was derived by log-rank test. Subsequently, both PFS and RFS were assessed for differences using Kaplan-Meier survival curves and log-rank test. Multivariate proportional Cox regression analysis adjusted for clinico-pathological variables was performed to examine end-points for NLR independent prognostic significance. Results There were 100 eligible patients (63 truly low-risk and 37 imperative cases). The optimal PFS log-rank test NLR cut-off value was 2.7. NLR > 2.7 was significantly associated with shorter PFS (p=0.01), and shorter upper tract RFS (p=0.03), but not with bladder RFS (p=0.90). Only positive high-grade cytology (HR 5.92, 95% CI 2.140 - 16.35, p=0.002) and NLR>2.7 (HR 4.28, 95% CI 1.34 - 13.72, p=0.014) independently predicted PFS in multivariate analysis. Recurrence and progression were not significantly linked in the low-risk subset. Conclusions This exploratory analysis showed that baseline NLR evaluation before first endoscopic UTUC treatment may be a valuable predictor and prognosticator of defined disease progression and of upper tract recurrence risk. In conjunction with high-grade urine cytology, NLR may improve risk stratification to optimize future individualized management.

Journal of endourology. 2020 Jun 29 [Epub ahead of print]

Michele Antonucci, Lorenzo Defidio, Mauro De Dominicis, Nicola Russo, Antonio Nacchia, Riccardo Lombardo, Anup Patel

"Cristo Re" General Hospital, dept. of urology, via delle Calasanziane 25, Roma, RM, Italy, 00167; ., Rome, Italy; ., Ospedale Cristo Re, Urology, Via delle calasanziane, 25, Rome, Italy, 00167; ., Ospedale Cristo Re, 220413, Urology, Roma, Lazio, Italy; ., Sant'Andrea Hospital, Rome, United States; ., Sant'Andrea Hospital, 117698, Roma, Lazio, Italy; ., Spire Roding, Urology, Roding Lane South, London, United Kingdom of Great Britain and Northern Ireland, IG4 5PZ; .