Evaluation of the neutrophil-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NC) for muscle-invasive bladder cancer (MIBC) and correlation with pathologic response to treatment.

Abstract

351 Background: Cancer associated inflammation, as measured by markers such as NLR, appears to impact on outcome. In MIBC, an elevated NLR> 2.5 prior to radical cystectomy (RC) is associated with a poorer prognosis (Gondo, 2011). We evaluated the pattern of change in NLR before (pre-NC), during (mid-NC) and after NC (pre-RC) and correlated this with pathological outcomes, to determine if NLR is of predictive value in this setting. Methods: AllMIBC pts treated with NC and RC between Jan 2005 – April 2013 were evaluated. Standard demographic, disease-related and biochemical parameters (Hb, LDH, albumin) and NLR were analyzed with univariate and multivariable logistic regression. The continuous variable pre-RC NLR was dichotomized using a cut-off of 2.5 based on area under the receiver-operator-curve analysis. Generalized linear mixed model was used to account for the time trend and co-linearity when assessing NLR change between pts who achieved pathological response (pathR) and non-responders. Results: Twenty-three patients were evaluable. Age, gender, ECOG, smoking, clinical stage, and hydronephrosis did not significantly predict for pathR. Pre-NC and mid-NC NLR did not predict for pathR. Pre-RC NLR <2.5 showed a trend towards association with pathR (p=0.05). The pattern of NLR change between responders and non-responders was significantly different (p=0.039). Non-responders exhibited a transient decrease in NLR during NC, followed by an increase in NLR pre-RC above its baseline; responders exhibited a sustained decrease in NLR which remained suppressed until RC (Figure: http://bit.ly/1bYC2wR). Conclusions: While there was no significant difference in pre-NC NLR between responders and non-responders, there was a significant difference in the pattern of NLR change during NC. We speculate that a sustained decrease in inflammatory burden during NC, as manifested by NLR, is associated with pathR. Despite limitations of a small retrospective study, our results may have potential translational and clinical implications.