Abstract
A large number of studies have investigated the prognostic value of the platelet-to-lymphocyte ratio (PLR) in patients diagnosed with urothelial carcinoma, but the evidence from these papers is conflicting. This systematic review and meta-analysis was carried out to assess the role of PLR in urothelial carcinoma patients. After a systematic search of the PubMed, Embase, Web of science databases, the associations between PLR and overall survival (OS), cancer-specific survival (CSS)/disease-specific survival (DSS), and relapse-free survival (RFS)/disease-free survival (DFS) were analyzed in urothelial carcinoma patients. The relationship between PLR and pathological results was also evaluated. A total of seven studies (eight cohorts) comprising 3171 patients were included. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) indicated the increased preoperative PLR predicted poor OS (HR = 1.14, 95% CI = 1.01- 1.27, p < 0.001), CSS/DSS (HR = 1.24, 95% CI = 1.08–1.40, p < 0.001), RFS/DFS (HR = 1.23, 95% CI = 1.09–1.38, p < 0.001). However, no significant correlation was found between elevated preoperative PLR and pathological results such as tumor grade, tumor necrosis and T stages. These findings suggest a high PLR is associated with reduced OS, CSS/DSS and RFS/DFS in urothelial carcinoma. Preoperative PLR may therefore be a predictive factor in this patient group.
Highlights
Urothelial carcinomas arise throughout the length of the urinary tract, though most develop in the lower urinary tract and are termed lower urinary tract urothelial carcinomas (LUTUC)
These findings suggest a high plateletto-lymphocyte ratio (PLR) is associated with reduced overall survival (OS), cancer-specific survival (CSS)/diseasespecific survival (DSS) and relapse-free survival (RFS)/disease-free survival (DFS) in urothelial carcinoma
The prognostic role of PLR in pathological results was investigated in 3 studies, and pathological T stage, tumor grade and tumor necrosis were included as main pathological results
Summary
Urothelial carcinomas arise throughout the length of the urinary tract, though most develop in the lower urinary tract and are termed lower urinary tract urothelial carcinomas (LUTUC). Urothelial carcinoma of the bladder (UCB) is the main type of LUTUC It is a common urinary malignancy [1], contributing to 7% of all new cancer diagnoses and 4% of all cancer mortality. An optimal method of pre-operative tumor staging is still debated, as imaging and local biopsy are insufficient for this purpose [3,4,5]. This makes it important to validate proposed preoperative prognostic biomarkers, as these may be able to improve risk stratification and clinical decision making for patients with urothelial carcinomas
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