Abstract
ABSTRACTBackground:Bladder cancer represents one of the most important clinical challenges in urologic practice. In this context, inflammation has an important role in the development and progression of many malignancies. The objective of the present study was to evaluate the prognostic value of pre-treatment Neutrophil to lymphocyte ratio (NLR) on the risk of recurrence and progression in patients with primary non-muscle invasive bladder cancer.Materials and Methods:Data obtained from 178 bladder cancer patients who underwent transurethral resection of bladder tumor (TURB) between July 2008 and December 2014 were evaluated prospectively. NLR was obtained from each patient before TURB and defined as the absolute neutrophil count divided by the absolute lymphocyte count. Cox proportional hazards regression model was performed to calculate disease recurrence and progression including NLR.Results:During the follow-up study (median: 53 months), 14 (23.3%) and 44 (37.9%) (p=0.04) patients respectively with NLR<3 and ≥3experienced recurrence and 2 (3.3%) and 14 (11.9%) experienced progression (p=0.06), respectively. At the multivariate Cox regression analysis, NLR ≥3 was associated with worse disease recurrence (HR: 2.84; p<0.01). No association was found regarding disease progression. The 5-year recurrence free survival was 49% and 62% in patients with NLR≥3 and <3 (p<0.01). The 5-year progression free survival was 77% and 93% in patients with NLR≥3 and <3 (p=0.69).Conclusion:NLR predicts disease recurrence but not disease progression in NMIBC patients. NLR alterations may depend of tumor inflammatory microenvironment.
Highlights
Bladder cancer represents one of the most important clinical challenges in urologic practice
To manage patients with non–muscle-invasive bladder cancer (NMIBC) based on their individual risk, based ibju | Neutrophil to lymphocyte ratio and bladder cancer on the course of the disease in well-controlled prospective randomized clinical trials, the European Organization for Research and Treatment of Cancer (EORTC) has developed risk tables to predict the individual risks for tumor recurrence or progression to muscle-invasive disease [4]
According to the EORTC risk table, using a scoring system based on previous recurrence rate, tumor number, tumor diameter, T category, World Health Organization (WHO) grade, and the presence of concurrent carcinoma in situ (CIS), to estimate the risk of disease recurrence and progression at 1 and 5 years, patients with bladder cancer were stratified into low, intermediate, and high-risk group, which may guide clinical management [5]
Summary
Bladder cancer represents one of the most important clinical challenges in urologic practice. The dilemma in the management of non–muscle-invasive bladder cancer (NMIBC) still remain the risk of recurrence ranging from 30% up to nearly 80% and depending on the risk profile, up to 45% of tumors may progress to muscle-invasive disease within 5 years after initial diagnosis [4]. To manage patients with NMIBC based on their individual risk, based ibju | Neutrophil to lymphocyte ratio and bladder cancer on the course of the disease in well-controlled prospective randomized clinical trials, the European Organization for Research and Treatment of Cancer (EORTC) has developed risk tables to predict the individual risks for tumor recurrence or progression to muscle-invasive disease [4].
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