Abstract
PurposeWe developed a novel inflammation-based model (NPS), which consisted of a neutrophil to lymphocyte ratio (NLR) and platelet count (PC), for assessing the prognostic role in patients with metastatic urothelial carcinoma (UC).Materials and MethodsWe performed a retrospective analysis of patients with metastatic UC who underwent systemic chemotherapy between January 1997 and December 2014 in Kaohsiung Chang Gung Memorial Hospital. The defined cutoff values for the NLR and PC were 3.0 and 400 × 103/μL, respectively. Patients were scored 1 for either an elevated NLR or PC, and 0 otherwise. The NPS was calculated by summing the scores, ranging from 0 to 2. The primary endpoint was overall survival (OS) by using Kaplan–Meier analysis. Multivariate Cox regression analysis was used to identify the independent prognostic factors for OS.ResultsIn total, 256 metastatic UC patients were enrolled. Univariate analysis revealed that patients with either a high NLR or PC had a significantly shorter survival rate compared with those with a low NLR (P = .001) or PC (P < .0001). The median OS in patients with NPS 0, 1, and 2 was 19.0, 12.8, and 9.3 months, respectively (P < .0001). Multivariate analysis revealed that NPS, along with the histologic variant, liver metastasis, age, and white cell count, was an independent factor facilitating OS prediction (hazard ratio 1.64, 95% confidence interval 1.20–2.24, P = .002).ConclusionThe NLR and PC are independent prognostic factors for OS in patients with metastatic UC. The NPS model has excellent discriminant ability for OS.
Highlights
Metastatic urothelial carcinoma (UC) is a lethal disease, and no major improvement has been achieved in the past 2 decades [1]
Univariate analysis revealed that patients with either a high neutrophil to lymphocyte ratio (NLR) or platelet count (PC) had a significantly shorter survival rate compared with those with a low NLR (P = .001) or PC (P < .0001)
Multivariate analysis revealed that new inflammation prognostic system (NPS), along with the histologic variant, liver metastasis, age, and white cell count, was an independent factor facilitating overall survival (OS) prediction
Summary
Metastatic urothelial carcinoma (UC) is a lethal disease, and no major improvement has been achieved in the past 2 decades [1]. Cisplatin-based combination chemotherapy remains the standard treatment of choice. UC responds effectively to the cisplatin-based chemotherapy initially, most patients experience disease progression later, and mortality is inevitable. The median overall survival (OS) on cisplatin-based chemotherapy is 12–14 months [2]. A small proportion of UC patients had a markedly effective response to chemotherapy. In previous clinical trials with durable follow-up, the 5-year survival rate of metastatic UC patients on cisplatin-based chemotherapy was approximately 10%–20% [3]. The diversity of treatment outcomes was attributed to the biologic heterogeneity of the tumor, as well as the spectrum of comorbidities of the patient, performance status, age, and disease burden. Developing a prognostic model was crucial for predicting patient outcome in daily practice and for stratifying patients in clinical trials
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
