TY - JOUR
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
N1 - Funding Information:
Funding/Support and role of the sponsor: This work was supported by a Centre Hospitalier Universitaire Lausanne, the Oesterreichische Nationalbank Anniversary Fund (project number 15363/2013), and the Medical-Scientific Fund of the Mayor of the City of Vienna (project number 14069/2014). The sponsors played a role in the design and conduct of the study, analysis and interpretation of the data, and preparation of the manuscript.
Publisher Copyright:
© 2015 European Association of Urology
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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U2 - 10.1016/j.euf.2015.03.001
DO - 10.1016/j.euf.2015.03.001
M3 - Article
C2 - 28723455
AN - SCOPUS:84983542329
SN - 2405-4569
VL - 2
SP - 79
EP - 85
JO - European Urology Focus
JF - European Urology Focus
IS - 1
ER -