Neutrophil-to-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy

PURPOSE - High-neutrophil to lymphocyte ratio (NLR) values have been shown to be associated with a poor prognosis in many human malignant tumors. We evaluated the correlation of the NLR with other variables in patients with muscle-invasive bladder cancer after radical cystectomy (RC); in particular, we evaluated chronological changes in the postoperative NLR.

METHODS - We included the data from a total of 110 patients who underwent RC for muscle-invasive bladder cancer. The NLR was calculated using complete blood counts determined before RC. Kaplan-Meier and Cox proportional regression analyses of recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were performed to identify significant prognostic variables.

RESULTS - The median patient age was 72 years (41-91 years). In univariate analysis, the pretreatment NLR (≥2.6 vs.<2.6) was associated with RFS (hazard ratio [HR] = 2.41, P = 0.008), CSS (HR = 2.89, P = 0.006), and OS (HR = 2.73, P = 0.002). In multivariate analysis, an NLR≥2.6 and an infiltrative growth pattern at the tumor invasion front were significantly associated with RFS (HR = 2.61, P = 0.023), CSS (HR = 2.58, P = 0.08), and OS (HR = 2.77, P = 0.004). Postoperative chronological analysis revealed that the NLR of 68 patients without recurrence remained low during follow-up, whereas the NLR of the remaining 42 patients with recurrence increased significantly in the last visit before recurrence was detected radiographically (P< 0.01).

CONCLUSIONS - The NLR and tumor growth pattern were strong predictors of prognosis for patients undergoing RC. Our results suggest that an increase in the NLR during follow-up after RC is a potential marker for the early detection of recurrence.

Urologic oncology. 2016 Mar 30 [Epub ahead of print]

Yosuke Morizawa, Makito Miyake, Keiji Shimada, Shunta Hori, Yoshihiro Tatsumi, Yasushi Nakai, Satoshi Anai, Nobumichi Tanaka, Noboru Konishi, Kiyohide Fujimoto

Department of Urology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Pathology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan; Department of Pathology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan., Department of Pathology, Nara Medical University, Nara, Japan., Department of Urology, Nara Medical University, Nara, Japan. 

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