Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy

Mihai Dorin Vartolomei,Morgan Rouprêt,Aurélie Mbeutcha,Évanguelos Xylinas ,Jose A Karam,Romain Mathiéu ,Karim Bensalah,Alon Z Weizer,Alberto Briganti,Ilaria Lucca,Andrea Haitel,Christian Seitz,Jay D Raman,Vitaly Margulis,Christopher G Wood,Nathalie Rioux‐Leclercq ,Michael Rink,Pierre I Karakiewicz,Harun Fajković ,Shahrokh F Shariat

doi:10.1007/s00345-016-1848-9

Abstract

ObjectiveSeveral retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort.MethodsPreoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models.ResultsAltered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03).ConclusionIn UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy.

Highlights

In upper tract urothelial carcinoma (UTUC), preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status
Outcomes were measured by time to disease recurrence or to cancer-specific death
Cause of death was determined by the treating physician, based on chart review corroborated by death certificates, or by death certificates alone [16]

Summary

Methods

Preoperative NLR was assessed in a multiinstitutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess. Mihai Dorin Vartolomei and Romain Mathieu have contributed as co-first authors

Results

Patients and methods

Discussion

Conclusion

Compliance with ethical standards