The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy

被引：37

作者：

Black, Anna J. ^{[1
]}

Zargar, Homayoun ^{[1
,2
]}

Zargar-Shoshtari, Kamran ^{[3
,4
]}

Fairey, Adrian S. ^{[5
]}

Mertens, Laura S. ^{[6
]}

Dinney, Colin P. ^{[7
]}

Mir, Maria C. ^{[8
,9
]}

Krabbe, Laura-Maria ^{[10
,11
]}

Cookson, Michael S. ^{[12
]}

Jacobsen, Niels-Erik ^{[5
]}

Griffin, Joshua ^{[13
]}

Montgomery, Jeffrey S. ^{[14
]}

Vasdev, Nikhil ^{[15
,16
]}

Yu, Evan Y. ^{[17
,18
]}

Xylinas, Evanguelos ^{[19
,20
]}

Campain, Nicholas J. ^{[21
]}

Kassouf, Wassim ^{[22
]}

Dall'Era, Marc A. ^{[23
]}

Seah, Jo-An ^{[24
]}

Ercole, Cesar E. ^{[8
]}

Horenblas, Simon ^{[6
]}

McGrath, John S. ^{[21
]}

Aning, Jonathan ^{[21
,25
]}

Shariat, Shahrokh F. ^{[19
,26
]}

Wright, Jonathan L. ^{[27
]}

Thorpe, Andrew C. ^{[16
]}

Morgan, Todd M. ^{[14
]}

Holzbeierlein, Jeff M. ^{[13
]}

Bivalacqua, Trinity J. ^{[28
]}

North, Scott ^{[29
,30
]}

Barocas, Daniel A. ^{[31
]}

Lotan, Yair ^{[10
]}

Grivas, Petros ^{[17
,18
,32
]}

Stephenson, Andrew J. ^{[8
]}

Shah, Jay B. ^{[7
,33
]}

van Rhijn, Bas W. ^{[6
]}

Spiess, Philippe E. ^{[3
]}

Daneshmand, Siamak ^{[34
]}

Sridhar, Srikala S. ^{[24
]}

Black, Peter C. ^{[1
]}

机构：

[1] Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada

[2] Western Hlth, Melbourne, Vic, Australia

[3] H Lee Moffitt Canc Ctr & Res Inst, Dept Genitourinary Oncol, Tampa, FL USA

[4] Univ Auckland, Auckland, New Zealand

[5] Univ Alberta, Edmonton, AB, Canada

[6] Antoni van Leeuwenhoek Hosp, Dept Urol, Netherlands Canc Inst, Amsterdam, Netherlands

[7] MD Anderson Canc Ctr, Dept Urol, Houston, TX USA

[8] Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA

[9] Fdn Inst Valenciano Oncol, Dept Urol, Valencia, Spain

[10] Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA

[11] Univ Munster, Dept Urol, Munster, Germany

[12] Univ Oklahoma, Coll Med, Dept Urol, Oklahoma City, OK 73190 USA

[13] Univ Kansas, Med Ctr, Dept Urol, Kansas City, KS 66103 USA

[14] Univ Michigan Hlth Syst, Dept Urol, Ann Arbor, MI USA

[15] Lister Hosp, Hertfordshire & Bedfordshire Urol Canc Ctr, Dept Urol, Stevenage, Herts, England

[16] Freeman Rd Hosp, Dept Urol, Newcastle Upon Tyne, Tyne & Wear, England

[17] Univ Washington, Dept Med, Div Oncol, Sch Med, Seattle, WA 98195 USA

[18] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA

[19] Presbyterian Hosp, Weill Cornell Med Coll, Dept Urol, New York, NY USA

[20] Paris Descartes Univ, Cochin Hosp, AP HP, Dept Urol, Paris, France

[21] Royal Devon & Exeter NHS Trust, Exeter Surg Hlth Serv Res Unit, Exeter Surg Hlth Serv, Dept Surg, Exeter, Devon, England

[22] McGill Univ, Hlth Ctr, Div Urol, Dept Surg, Montreal, PQ, Canada

[23] Univ Calif Davis, Davis Med Ctr, Dept Urol, Sacramento, CA 95817 USA

[24] Princess Margaret Hosp, Toronto, ON, Canada

[25] North Bristol NHS Trust, Bristol Urol Inst, Bristol, Avon, England

[26] Med Univ Vienna, Vienna Gen Hosp, Dept Urol, Vienna, Austria

[27] Univ Washington, Dept Urol, Seattle, WA 98195 USA

[28] Johns Hopkins Sch Med, James Buchanan Brady Urol Inst, Dept Urol, Baltimore, MD USA

[29] Cross Canc Inst, Edmonton, AB, Canada

[30] Univ Alberta, Dept Oncol, Edmonton, AB, Canada

[31] Vanderbilt Univ, Med Ctr, Dept Urol Surg, Nashville, TN USA

[32] Cleveland Clin, Taussig Canc Inst, Dept Hematol & Med Oncol, Cleveland, OH 44106 USA

[33] Stanford Univ, Dept Urol, Sch Med, Stanford, CA 94305 USA

[34] Univ Southern Calif, Inst Urol, USC Norris Comprehens Canc Ctr, Los Angeles, CA 90007 USA

来源：

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS | 2020年 / 38卷 / 01期

关键词：

MIBC; NLR; Neoadjuvant chemotherapy; Urothelial carcinoma; Radical cystectomy; UROTHELIAL CARCINOMA; PREDICTIVE-VALUE; INFLAMMATION; NLR;

D O I：

10.1016/j.urolonc.2019.09.023

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: The neutrophil-to-lymphocyte ratio (NLR) is an attractive marker because it is derived from routine bloodwork. NLR has shown promise as a prognostic factor in muscle invasive bladder cancer (MIBC) but its value in patients receiving neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is not yet established. Since NLR is related to an oncogenic environment and poor antitumor host response, we hypothesized that a high NLR would be associated with a poor response to NAC and would remain a poor prognostic indicator in patients receiving NAC. Methods: A retrospective analysis was performed on patients with nonmetastatic MIBC (cT2-4aN0M0) who received NAC prior to RC between 2000 and 2013 at 1 of 19 centers across Europe and North America. The pre-NAC NLR was used to split patients into a low (NLR <= 3) and high (NLR > 3) group. Demographic and clinical parameters were compared between the groups using Student's t test, chi-squared, or Fisher's exact test. Putative risk factors for disease-specific and overall survival were analyzed using Cox regression, while predictors of response to NAC (defined as absence of MIBC in RC specimen) were investigated using logistic regression. Results: Data were available for 340 patients (199 NLR <= 3, 141 NLR > 3). Other than age and rate of lymphovascular invasion, demographic and pretreatment characteristics did not differ significantly. More patients in the NLR > 3 group had residual MIBC after NAC than the NLR <= 3 group (70.8% vs. 58.3%, P = 0.049). NLR was the only significant predictor of response (odds ratio: 0.36, P = 0.003) in logistic regression. NLR was a significant risk factor for both disease-specific (hazard ratio (HR): 2.4, P = 0.006) and overall survival (HR:1.8, P = 0.02). Conclusion: NLR > 3 was associated with a decreased response to NAC and shorter disease-specific and overall survival. This suggests that NLR is a simple tool that can aid in MIBC risk stratification in clinical practice. (C) 2019 Elsevier Inc. All rights reserved.

引用

页码：3.e17 / 3.e27

页数：11

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