Neutrophil-to-lymphocyte ratio: could it play a prognostic role in unselected non–muscle-invasive bladder cancer?

Vincenzo Serretta1, Gabriele Ventura1, Giulio Bevilacqua1, Sandro Billeci1, Cristina Scalici Gesolfo1, Marco Vella1, Chiara Sanfilippo2
  • 1 Università di Palermo, Sezione di Urologia, Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche (Palermo)
  • 2 Fondazione GSTU, Statistics (Palermo)

Objective

Neutrophil-to lymphocyte ratio (NLR) has been considered an useful biomarker of systemic inflammatory response in several tumor types from several studies. In patients with muscle invasive bladder cancer (MIBC) undergoing cystectomy a higher preoperative NLR has been associated with poor prognosis and pathologic upstaging but its predictive value in non-muscle-invasive bladder cancer (NMIBC)up to date has been rarely studied with uncertain results. An independent association of NLR with unfavorable clinical outcome in selected patients with high-risk NMIBC, identifying patients failing intravesical immune therapy has been recently found by D’Andrea and coll (1) .
Our study had the aim to evaluate whether NLR could predict pathologic upstaging and recurrence in unselected patients undergoing transurethral resection (TUR) for primary NMIBC.

Materials and Methods

We reviewed th medical records of 162 consecutive patients submitted to TUR for primary NMIBC between January 2013 and December 2015. Informed consent and ethical committee approval were obtained. Exclusion criteria were presence of other malignancies, known autoimmune or inflammatory diseases, clinical evidence of advanced bladder cancer.
Statistical analysis: numeric values were compared by Wilcoxon-Mann-Whitney test. Chi-square test was used for the comparison of the non-numeric values. A NLR cut-off value of 3 according to recent literature was adopted (1). A p value <0.05 was considered statistically significant (Software R version 3.4.2)

Results

The study cohort comprised 142 (87.7%) men and 20 women with a median age of 70 (23-90) years.
Fifty four (33.3%) patients were active smokers, 73 (45.1%) former smokers with a median number of 20 cigarettes per day and a median smoking period of 25 years, while 35 (21.6%) patients never smoked.
Out of 142 patients 32 (19.8%) received a pathological diagnosis of MIBC while130 (80.2%) of NMIBC. Particularly, high-grade tumors were found in 76 (46.9%) patients. Among NMIBC, 30 T1 (23%), 3 Tis (1.9%) and 42 (32.3%) high-grade tumors were diagnosed. Tumors were multiple in 131 patients (80.9%). Tumor size was <2cm, between 2 and 5 and more than 5 cm in 81 (50%), 77 (47.5%) and 4 (2.5%) patients, respectively.The median NLR was 2.7 (range: 0.2-42.1).
At a median follow-up of 25 months (range: 3-48 ) 54 (39.9%) patients recurred. Mean time to recurrence was 12.9 months
We didn't find any correlation between NLR (cut-off of 3) and age (p=0.85), gender (p=0.38), smoking status (p=0.50), G-grade (p=0.24), tumor size (p=0.77) and the adoption of adjuvant intravesical therapy (p=0.48). Moreover, no correlation was detected between NLR and recurrence (p=0.17)

However, a statistically significant association was detected between NLR and multiplicity (single vs multiple) (p=0.018) and with T-stage (NMIBC vs MIBC) (p<0.005).

Discussions

Recent studies suggest that NLR could be an independent prognostic value in advanced bladder cancer and in high risk NMIBC. In our experience in consecutive patients undergoing TUR for a clinical diagnosis of NMIBC we found a statistically significant association of NLR with multiplicity and T-stage, both factors enhancing host immune response. However, we did not detect any relation between NLR and patients’ outcome in terms of recurrence.

Conclusion

NLR seems not to have a predictive value for recurrence in unselected NMIBC treated in common clinical practice, even if related with tumor multiplicity and T-stage.

Reference

1. D'Andrea D et al.Clin Genitourin Cancer. 2017;15:e755-e764.

Acknowledgments: We wish to thank the GSTU Foundation for the statistical support

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