The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy

Validation and Meta-analysis

Ilaria Lucca, Patrice Jichlinski, Shahrokh F. Shariat, Morgan Rouprêt, Malte Rieken, Luis A. Kluth, Michael Rink, Romain Mathieu, Aurelie Mbeutcha, Agnes Maj-Hes, Harun Fajkovic, Alberto Briganti, Christian Seitz, Pierre I. Karakiewicz, Michela de Martino, Yair Lotan, Marko Babjuk, Tobias Klatte

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). Objective To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. Design, setting, and participants The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. Outcome measurements and statistical analysis Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. Results and limitations A high NLR (≥2.7) was associated with advanced pathological tumor stages (p < 0.001), lymph node involvement (p < 0.001), lymphovascular invasion (p = 0.008), and positive soft0tissue surgical margins (p = 0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01–1.22; p = 0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07–1.37, p = 0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01–1.92) for OS and 1.51 (95% CI 1.17–1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. Conclusion In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. Patient summary We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.

Original languageEnglish (US)
Pages (from-to)79-85
Number of pages7
JournalEuropean Urology Focus
Volume2
Issue number1
DOIs
StatePublished - Apr 1 2016

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Cystectomy
Meta-Analysis
Urinary Bladder
Neutrophils
Lymphocytes
Carcinoma
Survival
Confidence Intervals
Neoplasms
Biomarkers
Lymph Nodes
Proportional Hazards Models
Urinary Bladder Neoplasms
Multivariate Analysis
Retrospective Studies
Databases
Neoplasm Metastasis

Keywords

  • Meta-analysis
  • Neutrophil-to-lymphocyte ratio
  • Radical cystectomy
  • Survival
  • Urothelial carcinoma of the bladder

ASJC Scopus subject areas

  • Urology

Cite this

The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy : Validation and Meta-analysis. / Lucca, Ilaria; Jichlinski, Patrice; Shariat, Shahrokh F.; Rouprêt, Morgan; Rieken, Malte; Kluth, Luis A.; Rink, Michael; Mathieu, Romain; Mbeutcha, Aurelie; Maj-Hes, Agnes; Fajkovic, Harun; Briganti, Alberto; Seitz, Christian; Karakiewicz, Pierre I.; de Martino, Michela; Lotan, Yair; Babjuk, Marko; Klatte, Tobias.

In: European Urology Focus, Vol. 2, No. 1, 01.04.2016, p. 79-85.

Research output: Contribution to journalArticle

Lucca, I, Jichlinski, P, Shariat, SF, Rouprêt, M, Rieken, M, Kluth, LA, Rink, M, Mathieu, R, Mbeutcha, A, Maj-Hes, A, Fajkovic, H, Briganti, A, Seitz, C, Karakiewicz, PI, de Martino, M, Lotan, Y, Babjuk, M & Klatte, T 2016, 'The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy: Validation and Meta-analysis', European Urology Focus, vol. 2, no. 1, pp. 79-85. https://doi.org/10.1016/j.euf.2015.03.001
Lucca, Ilaria ; Jichlinski, Patrice ; Shariat, Shahrokh F. ; Rouprêt, Morgan ; Rieken, Malte ; Kluth, Luis A. ; Rink, Michael ; Mathieu, Romain ; Mbeutcha, Aurelie ; Maj-Hes, Agnes ; Fajkovic, Harun ; Briganti, Alberto ; Seitz, Christian ; Karakiewicz, Pierre I. ; de Martino, Michela ; Lotan, Yair ; Babjuk, Marko ; Klatte, Tobias. / The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy : Validation and Meta-analysis. In: European Urology Focus. 2016 ; Vol. 2, No. 1. pp. 79-85.
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abstract = "Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). Objective To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. Design, setting, and participants The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. Outcome measurements and statistical analysis Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. Results and limitations A high NLR (≥2.7) was associated with advanced pathological tumor stages (p < 0.001), lymph node involvement (p < 0.001), lymphovascular invasion (p = 0.008), and positive soft0tissue surgical margins (p = 0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95{\%} confidence interval [CI] 1.01–1.22; p = 0.029) and cancer-specific survival (CSS) (HR 1.21, 95{\%} CI 1.07–1.37, p = 0.003). The discrimination of the multivariate models increased by 0.2{\%} on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95{\%} CI 1.01–1.92) for OS and 1.51 (95{\%} CI 1.17–1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. Conclusion In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. Patient summary We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.",
keywords = "Meta-analysis, Neutrophil-to-lymphocyte ratio, Radical cystectomy, Survival, Urothelial carcinoma of the bladder",
author = "Ilaria Lucca and Patrice Jichlinski and Shariat, {Shahrokh F.} and Morgan Roupr{\^e}t and Malte Rieken and Kluth, {Luis A.} and Michael Rink and Romain Mathieu and Aurelie Mbeutcha and Agnes Maj-Hes and Harun Fajkovic and Alberto Briganti and Christian Seitz and Karakiewicz, {Pierre I.} and {de Martino}, Michela and Yair Lotan and Marko Babjuk and Tobias Klatte",
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T1 - The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy

T2 - Validation and Meta-analysis

AU - Lucca, Ilaria

AU - Jichlinski, Patrice

AU - Shariat, Shahrokh F.

AU - Rouprêt, Morgan

AU - Rieken, Malte

AU - Kluth, Luis A.

AU - Rink, Michael

AU - Mathieu, Romain

AU - Mbeutcha, Aurelie

AU - Maj-Hes, Agnes

AU - Fajkovic, Harun

AU - Briganti, Alberto

AU - Seitz, Christian

AU - Karakiewicz, Pierre I.

AU - de Martino, Michela

AU - Lotan, Yair

AU - Babjuk, Marko

AU - Klatte, Tobias

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). Objective To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. Design, setting, and participants The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. Outcome measurements and statistical analysis Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. Results and limitations A high NLR (≥2.7) was associated with advanced pathological tumor stages (p < 0.001), lymph node involvement (p < 0.001), lymphovascular invasion (p = 0.008), and positive soft0tissue surgical margins (p = 0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01–1.22; p = 0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07–1.37, p = 0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01–1.92) for OS and 1.51 (95% CI 1.17–1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. Conclusion In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. Patient summary We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.

AB - Background The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). Objective To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. Design, setting, and participants The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. Outcome measurements and statistical analysis Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. Results and limitations A high NLR (≥2.7) was associated with advanced pathological tumor stages (p < 0.001), lymph node involvement (p < 0.001), lymphovascular invasion (p = 0.008), and positive soft0tissue surgical margins (p = 0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01–1.22; p = 0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07–1.37, p = 0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01–1.92) for OS and 1.51 (95% CI 1.17–1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. Conclusion In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. Patient summary We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.

KW - Meta-analysis

KW - Neutrophil-to-lymphocyte ratio

KW - Radical cystectomy

KW - Survival

KW - Urothelial carcinoma of the bladder

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JO - European Urology Focus

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