Validation of the Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in a Large Cohort of Chinese Patients with Upper Tract Urothelial Carcinoma

Background: The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor in various types of carcinomas. The aim of this study was to investigate the prognostic value of pretreatment NLR in a large cohort of Chinese patients with upper tract urothelial carcinoma (UTUC). Methods: We retrospectively analyzed the medical data of 656 UTUC patients who underwent radical nephroureterectomy (RNU) from 2001 to 2011 at Peking University First Hospital. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff point of pretreatment NLR. Uni- and multi-variate analyses were used to identify the prognostic factors for cancer-specific survival (CSS) and intravesical recurrence-free survival (IVRFS). Results: The optimal cutoff point of pretreatment NLR was 2.40 by ROC curves, by which patients with high NLR (NLR >= 2.40) and low NLR (NLR <2.40) accounted for 314 (47.9%) and 342 (52.1%) patients, respectively. Patients with a high pretreatment NLR tended to have high tumor grades (chi(2) = 15.725, P<0.001), high tumor stages (chi(2) = 25.416, P<0.001), tumor sizes 5 cm (chi(2) = 8.213, P=0.005), ipsilateral hydronephrosis (chi(2) = 4.624, P=0.033), and concomitant carcinoma in situ(CIS) (chi(2) = 9.517, P=0.003). A high pretreatment NLR (hazard ratio [HR] = 1.820, P=0.001), main tumor diameter 5 cm (HR = 1.789, P=0.009), lymph node metastasis (HR = 1.863, P=0.024), and high tumor stage (HR = 1.745, P<0.001) independently predicted poor CSS after surgery, while only concomitant carcinoma in situ(CIS) (HR = 2.164, P=0.034), ureteroscopy before surgery (HR = 1.701, P=0.015), and high tumor grade (HR = 1.645, P=0.018) were independent predictors of IVRFS after RNU. Conclusions: The pretreatment NLR was related to some adverse clinicopathological features and was an independent predictor of CSS, although not IVRFS, in Chinese UTUC patients.