Usefulness of the Neutrophil/Lymphocyte Ratio as Predictor of Recurrence and Progression of Non-Muscle-Invasive Bladder Carcinoma

  • Nuno Ramos Serviço de Urologia, Hospital Garcia de Orta, EPE, Almada, Portugal
  • Celso Marialva Serviço de Urologia, Hospital Garcia de Orta, EPE, Almada, Portugal
  • Vanessa Metrogos Serviço de Urologia, Hospital Garcia de Orta, EPE, Almada, Portugal
  • João Paulo Rosa Serviço de Urologia, Hospital Garcia de Orta, EPE, Almada, Portugal
  • Nelson Menezes Serviço de Urologia, Hospital Garcia de Orta, EPE, Almada, Portugal

Abstract

Objectives: Assess whether the neutrophil-lymphocyte ratio (RNL) can predict the risk of recurrence and progression of patients with the non–muscle-invasive bladder carcinoma (CBNMI).


Material & Methods: It was performed a retrospective analysis of patients diagnosed with CBNMI after a resection of the bladder tumor (RTUV), between January 2013 and December 2014. Patients who had no white blood cell count prior to surgery and patients with synchronous tumors were excluded. It was subsequently performed a multivariate statistical analysis with SPSS 22.0® software, with the following variables: age, gender, time of recurrence or disease progression (in months), NLR, tumor size (≤ 3 or >3cm), multiple tumors, histology and tumor initial grade.


Results: The sample consists of 84 patients, 79.8% were males and the average age was 69 years.


In 67.9% of the patients the initial tumor histology was pTa and in 77.4% was a low-grade tumor. In 21.4% of patients the tumor was multiple and in 33.3% the tumor was larger than 3 cm.


Nineteen-percent of patients had recurrence of tumor and progression was verifyed in 16.4%. Patients with RNL>3.32 presented pT1 as initial tumor histology more often (p=0.018).
In a multivariate analysis, the RNL> 3.32 was found to be associated with a higher recurrence or progression of tumor (hazard ratio [HR] = 2.94; 95% CI: 1.27-6.8; p=0012.).


Conclusions: In conclusion, this study states that RNL may be an useful predictor of recurrence or progression of tumor in patients with CBNMI, valuable in the clinical decision.

References

1. Babjuk M, Burger M, Zigeuner R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. European urology. 2013;64:639-653.
2. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. European urology. 2017;71:96-108.
3. Ferlay J, Randi G, Bosetti C, et al. Declining mortality from bladder cancer in Europe. BJU international. 2008;101:11-19.
4. Albayrak S, Zengin K, Tanik S, et al. Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer? The Kaohsiung journal of medical sciences. 2016;32:327-333.
5. Ogihara K, Kikuchi E, Yuge K, et al. The Preoperative Neutrophil-to-lymphocyte Ratio is a Novel Biomarker for Predicting Worse Clinical Outcomes in Non-muscle Invasive Bladder Cancer Patients with a Previous History of Smoking. Annals of surgical oncology. 2016;23:1039-1047.
6. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. European urology. 2006;49:466-465; discussion 475-467.
7. Van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. European urology. 2009;56:430-442.
8. Xylinas E, Kent M, Kluth L, et al. Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder. British journal of cancer. 2013;109:1460-1466.
9. Mbeutcha A, Shariat SF, Rieken M, et al. Prognostic significance of markers of systemic inflammatory response in patients with non-muscle-invasive bladder cancer. Urologic oncology. 2016;34:483 e417-483 e424.
10. Kluth LA, Black PC, Bochner BH, et al. Prognostic and Prediction Tools in Bladder Cancer: A Comprehensive Review of the Literature. European urology. 2015;68:238-253.
11. Wei Y, Jiang YZ, Qian WH. Prognostic role of NLR in urinary cancers: a meta-analysis. PloS one. 2014;9:e92079.
12. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surgical oncology. 2014;23:31-39.
13. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future oncology. 2010;6:149-163.
14. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144:646-674.
15. Potretzke A, Hillman L, Wong K, et al. NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder. Urologic oncology. 2014;32:631-636.
16. Ozyalvacli ME, Ozyalvacli G, Kocaaslan R, et al. Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2015;9:E126-131.
17. Marchioni M, Primiceri G, Ingrosso M, et al. The Clinical Use of the Neutrophil to Lymphocyte Ratio (NLR) in Urothelial Cancer: A Systematic Review. Clinical genitourinary cancer. 2016;14:473-484.
18. Viers BR, Boorjian SA, Frank I, et al. Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. European urology. 2014;66:1157-1164.
19. Budczies J, Klauschen F, Sinn BV, et al. Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PloS one. 2012;7:e51862.
20. Celik O, Akand M, Keskin MZ, Yoldas M, Ilbey YO. Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm. European review for medical and pharmacological sciences. 2016;20:652-656.
21. Favilla V, Castelli T, Urzi D, et al. Neutrophil to lymphocyte ratio, a biomarker in non-muscle invasive bladder cancer: a single-institutional longitudinal study. International braz j urol : official journal of the Brazilian Society of Urology. 2016;42:685-693.
22. Van Rhijn BW, Zuiverloon TC, Vis AN, et al. Molecular grade (FGFR3/MIB-1) and EORTC risk scores are predictive in primary non-muscle-invasive bladder cancer. European urology. 2010;58:433-441.
23. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? The Lancet. 2001;357:539-545.
24. Hashimoto T, Ohno Y, Nakashima J, Gondo T, Ohori M, Tachibana M. Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinoma. World journal of urology. 2013;31:953-958.
25. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of surgical oncology. 2012;19:217-224.
26. Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Annals of surgery. 2009;250:141-151.
27. Kim M, Moon KC, Choi WS, et al. Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma. World journal of urology. 2015;33:1439-1457.
28. Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013;15:323-328.
29. Ubukata H, Motohashi G, Tabuchi T, Nagata H, Konishi S, Tabuchi T. Evaluations of interferon-gamma/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients. Journal of surgical oncology. 2010;102:742-747.
30. Gondo T, Nakashima J, Ohno Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79:1085-1091.
31. Yoshida T, Kinoshita H, Yoshida K, et al. Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine. 2016;37:10067-10074.
Published
2017-12-16
How to Cite
RAMOS, Nuno et al. Usefulness of the Neutrophil/Lymphocyte Ratio as Predictor of Recurrence and Progression of Non-Muscle-Invasive Bladder Carcinoma. Acta Urológica Portuguesa, [S.l.], v. 34, n. 3-4, p. 13-20, dec. 2017. ISSN 2387-0419. Available at: <http://www.actaurologicaportuguesa.com/index.php/aup/article/view/46>. Date accessed: 20 apr. 2018. doi: https://doi.org/10.24915/aup.34.3-4.46.