MP55-17 PRE-TREATMENT NEUTROPHIL-TO-LYMPHOCYTE RATIO AS PREDICTOR OF ADVERSE OUTCOMES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER

Abstract

Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, 610 University Avenue, Toronto,Ontario, Canada M5G 2M9Background: An elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor outcome in various tumours. Its prognosticutility in patients with urothelial carcinoma of the bladder (UCB) undergoing radical cystectomy (RC) is yet to be fully elucidated.Methods: A cohort of patients undergoing RC for UCB in a tertiary referral centre between 1992 and 2012 was analysed.Neutrophil-to-lymphocyte ratio was computed using complete blood counts performed pre-RC, or before neo-adjuvantchemotherapy where applicable. Time-dependent receiver operating characteristic curves were used to determine the optimalcutoff point for predicting recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). The predictiveability of NLR was assessed using Kaplan–Meier analyses and multivariable Cox proportional hazards models. The likelihood-ratiotest was used to determine whether multivariable models were improved by including NLR.Results: The cohort included 424 patients followed for a median of 58.4 months. An NLR of 3 was determined as the optimal cutoffvalue. Patients with an NLRX3.0 had significantly worse survival outcomes (5y-RFS: 53% vs 64%, log-rank P¼0.013; 5y-CSS: 57% vs75%, log-rank Po0.001; 5y-OS: 43% vs 64%, log-rank Po0.001). After adjusting for disease-specific predictors, an NLR X3.0 wassignificantly associated with worse RFS (HR¼1.49; 95% CI¼1.12–2.0, P¼0.007), CSS (HR¼1.88; 95% CI¼1.39–2.54, Po0.001) andOS (average HR¼1.67; 95% CI¼1.17–2.39, P¼0.005). The likelihood-ratio test confirmed that prognostic models were improvedby including NLR.Conclusions: Neutrophil-to-lymphocyte ratio is an inexpensive prognostic biomarker for patients undergoing RC for UCB. It offerspre-treatment prognostic value in addition to established prognosticators and may be helpful in guiding treatment decisions.Radical cystectomy (RC) with pelvic lymph node dissectionis the standard treatment for muscle-invasive (MI) urothelialcarcinoma of the bladder (UCB) and is recommended for patientswith non-muscle-invasive (NMI) UCB with high risk ofprogression (Clark et al,2013).Despitecurativeintent,diseaserecurs in a significant proportion of patients and 5-year survival