Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non-muscle-invasive Bladder Cancer

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).

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).

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%).

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.

Clinical genitourinary cancer. 2018 Jul 06 [Epub ahead of print]

Mihai Dorin Vartolomei, Matteo Ferro, Francesco Cantiello, Giuseppe Lucarelli, Savino Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Ettore De Berardinis, Rocco Damiano, Sisto Perdona, Paolo Verze, Roberto La Rocca, Marco Borghesi, Riccardo Schiavina, Eugenio Brunocilla, Gilberto L Almeida, Pierluigi Bove, Estevao Lima, Giovanni Grimaldi, Riccardo Autorino, Nicolae Crisan, Abdal Rahman Abu Farhan, Michele Battaglia, Vincenzo Serretta, Giorgio Ivan Russo, Giuseppe Morgia, Daniela Terracciano, Gennaro Musi, Ottavio de Cobelli, Vincenzo Mirone, Shahrokh F Shariat

Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania., Division of Urology, European Institute of Oncology, Milan, Italy. Electronic address: ., Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy., Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy., Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy; Humanitas University, Department of Biomedical Science, Rozzano (Milan), Italy., Department of Urology, Sapienza University of Rome, Rome, Italy., Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy., Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy., Department of Urology, University of Bologna, Bologna, Italy., Departamento de Urologia, University of Vale do Itajaí, Itajaí, Brasil., Division of Urology, Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University of Rome, Rome, Italy., Life and Health Sciences Research Institute, University of Minho, Braga, Portugal., Division of Urology, Virginia Commonwealth University, Richmond, VA., Department of Urology, University of Medicine and Pharmacy "Iuliu Haţeganu," Cluj-Napoca, Romania., Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy., Department of Urology, University of Catania, Catania, Italy., Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy., Division of Urology, European Institute of Oncology, Milan, Italy., Division of Urology, European Institute of Oncology, Milan, Italy; Università degli Studi di Milano, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.