TY - JOUR
T1 - Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy
AU - Vartolomei, Mihai Dorin
AU - Mathieu, Romain
AU - Margulis, Vitaly
AU - Karam, Jose A.
AU - Rouprêt, Morgan
AU - Lucca, Ilaria
AU - Mbeutcha, Aurélie
AU - Seitz, Christian
AU - Karakiewicz, Pierre I.
AU - Fajkovic, Harun
AU - Wood, Christopher G.
AU - Weizer, Alon Z.
AU - Raman, Jay D.
AU - Rioux-Leclercq, Nathalie
AU - Haitel, Andrea
AU - Bensalah, Karim
AU - Rink, Michael
AU - Briganti, Alberto
AU - Xylinas, Evanguelos
AU - Shariat, Shahrokh F.
N1 - Funding Information:
Open access funding provided by Medical University of Vienna. R. M. is supported by the Scholarship Foundation of the Republic of Austria—OeAD and by the EUSP Scholarship—European Association of Urology. M. D. V is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/133377 and University of Medicine and Pharmacy, Targu Mures Romania contract number 17800/2015.
Publisher Copyright:
© 2016, The Author(s).
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objective: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort. Methods: Preoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models. Results: Altered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03). Conclusion: In UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy.
AB - Objective: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort. Methods: Preoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models. Results: Altered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03). Conclusion: In UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy.
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U2 - 10.1007/s00345-016-1848-9
DO - 10.1007/s00345-016-1848-9
M3 - Article
C2 - 27209168
AN - SCOPUS:84969869841
SN - 0724-4983
VL - 35
SP - 121
EP - 130
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
ER -