The Clinical Use of the Neutrophil to Lymphocyte Ratio (NLR) in Urothelial Cancer: A Systematic Review.

The neutrophil to lymphocyte ratio (NLR) is an inflammatory index that has been considered as a potential prognostic factor in human cancer. The aim of this study was to evaluate the available evidence regarding the NLR as a prognostic value in patients affected by urothelial cancer. This literature review, including papers on NLR in urothelial cancers, was done on PubMed/Medline and Cochrane libraries in November 2015. The selection of the articles followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Twenty-three of 99 articles fulfilled all the inclusion criteria, including data on 6240 patients affected by urothelial cancers. Overall, cancer-specific, and recurrence-free survival were evaluated as the main oncological outcomes. There was significant heterogeneity among studies, and the majority of studies were of poor quality. Overall, NLR was considered as a prognostic marker in 87.5%, 80%, and 60% of the studies on upper tract urothelial cancer, urothelial bladder cancer, and metastatic and advanced disease, respectively. The NLR cut-off value ranged between 2 and 5. A high NLR was associated with worse overall, cancer-specific, and recurrence-free survival. NLR is a widely available, easy-to-collect, costless, prognostic marker in urothelial cancers. Its clinical use still remains under investigation, especially for the need for cut-off values, particularly in different subsets of patients.

Clinical genitourinary cancer. 2016 Apr 22 [Epub ahead of print]

Michele Marchioni, Giulia Primiceri, Manuela Ingrosso, Roberta Filograna, Pietro Castellan, Piergustavo De Francesco, Luigi Schips

Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. Electronic address: ., Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Division of Molecular Metabolism, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden., Department of Urology, Robotic Unit, ASL Abruzzo 2, "SS. Annunziata" Hospital, Chieti, Italy., Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Department of Urology, Robotic Unit, ASL Abruzzo 2, "SS. Annunziata" Hospital, Chieti, Italy.