MP65-08 THE NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A PROGNOSTIC FACTOR FOR PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER FOLLOWING RADICAL CYSTECTOMY

Abstract

Introduction: Pre-treatment neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse pathology or survival in a variety of malignancies, including urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Whether the prognostic value of NLR is retained, or even increased, when measured postoperatively remains not well studied. In this study, we evaluated the association of preoperative and postoperative NLR with oncological outcomes following RC. Methods: 132 consecutive patients with UCB treated with open RC were analyzed. NLR was analyzed both as a continuous variable and as a categorical variable using a cut-off of 2.7 based on previous studies. NLR was recorded as followed: before surgery (within 15 days prior to RC, [NLR1]), postoperatively (within 2 days [NLR2], between 7 and 15 days after RC before discharge [NLR3], few days before the evidence of recurrence or last available follow up [NLR4]. ∆NLR was calculated as the difference between NLR2 and NLR1 (NLR∆1) and between NLR 2 and NLR3 (NLR∆2). Tumour stage, lymphovascular invasion (LVI) and lymph node involvement were collected. Cancer-specific mortality (CSM), all-cause mortality (ACM) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariate logistic regression and Cox proportional hazard models were used to analyze the association of NLR with extravesical disease, LVI, lymph node involvement, recurrence of disease and mortality. Results: During a follow up of 15.9 months, 45 (34.1%) patients had a recurrence of UBC, 60 (45.4%) patients died, 38 (28.8%) of UCB and 22 (16.7%) of other cause. 64 (48.5%) have no evidence of disease at follow-up. When assessed by multivariable analysis NLR1 remained independently associated with a significantly increased risk of extravescical disease (pT 3-4) [OR: 1.4, p<0.01] and Lymphovascular invasion [OR: 1.40, p<0.01]. NLR4 was independently associated with a significantly increased risk of CSM [HR=1.14, p=0.013]. In a postoperative model, NLR3 was found to be an independent predictor of ACM [HR=1.11, 95%, p=0.01]. NLR1 was associated with a significantly increased risk of recurrence in the univariable preoperative model [HR=1.9, p=0.05] while in the postoperative model, NLR4 remained independently associated with a significantly increased risk of recurrence [HR 1.13, p=0.03]. Conclusions: In patients with UCB treated with RC, NLR is associated with more advanced tumour stage, LVI, lymph node metastasis and higher CSM. Furthermore, the variation of NLR after surgery might play a role to predict higher ACM and RFS.