Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Non-Muscle Invasive Bladder Cancer treated with Intravesical Bacillus Calmette–Guérin and the Relationship with the CUETO Scoring Model Significance of the NLR with CUETO model
Urology Journal,
Vol. 19 No. 04 (2022),
,
Page 281-288
https://doi.org/10.22037/uj.v18i.6765
Abstract
Purpose: In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer (NMIBC).
Materials and Methods: From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette–Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29.
Results: One hundred-eight patients (38.4%) displayed a high NLR (> 2.29). In Kaplan–Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < .001) and progression-free survival (PFS) (P = .002). CUETO scores were associated with RFS (P < .001), but not with PFS (P = .423). A combination of NLRs and the CUETO risk model correlated with RFS (P < .001) and PFS (P = .002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < .05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < .05).
Conclusion: In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression.
- Neutrophil-to-lymphocyte ratio; Bacillus Calmette–Guérin; Club Urológico Español de Tratamiento Oncológico risk model; Survival
How to Cite
References
2. Babjuk M, Burger M, Zigeuner R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64:639-53.
3. Babjuk M, Bohle A, Burger M, et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol. 2017;71:447-61.
4. Malmstrom PU, Sylvester RJ, Crawford DE, et al. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guerin for non-muscle-invasive bladder cancer. Eur Urol. 2009;56:247-56.
5. Cambier S, Sylvester RJ, Collette L, et al. EORTC Nomograms and Risk Groups for Predicting Recurrence, Progression, and Disease-specific and Overall Survival in Non-Muscle-invasive Stage Ta-T1 Urothelial Bladder Cancer Patients Treated with 1-3 Years of Maintenance Bacillus Calmette-Guerin. Eur Urol. 2016;69:60-9.
6. Hidas G, Pode D, Shapiro A, et al. The natural history of secondary muscle-invasive bladder cancer. BMC Urol. 2013;13:23.
7. Fernandez-Gomez J, Madero R, Solsona E, et al. Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol. 2009;182:2195-203.
8. Getzler I, Bahouth Z, Nativ O, Rubinstein J, Halachmi S. Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer. BMC Urol. 2018;18:90.
9. Lee BS, Lee SH, Son JH, et al. Neutrophil-lymphocyte ratio predicts survival in patients with advanced cholangiocarcinoma on chemotherapy. Cancer Immunol Immunother. 2016;65:141-50.
10. Viers BR, Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Tollefson MK. Preoperative neutrophil-lymphocyte ratio predicts death among patients with localized clear cell renal carcinoma undergoing nephrectomy. Urologic Oncology-Seminars and Original Investigations. 2014;32:1277-84.
11. Ceylan C, Doluoglu OG, Keles I, et al. Importance of the neutrophil-to-lymphocyte ratio in muscle-invasive and non-muscle invasive bladder tumors. Urologia. 2014;81:120-4.
12. Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors: a summary and commentary. Int J Surg Pathol. 2005;13:143-53.
13. Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am. 2003;30:765-76.
14. Choi SY, Ryu JH, Chang IH, et al. Predicting recurrence and progression of non-muscle-invasive bladder cancer in Korean patients: a comparison of the EORTC and CUETO models. Korean J Urol. 2014;55:643-9.
15. Sylvester RJ, van der Meijden APM, 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;49:466-77.
16. Lamm DL, Blumenstein BA, Crawford ED, et al. A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcinoma of the bladder. N Engl J Med. 1991;325:1205-9.
17. Mano R, Baniel J, Shoshany O, et al. Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer. Urologic Oncology-Seminars and Original Investigations. 2015;33.
18. Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288-95.
19. Ku JH, Kang M, Kim HS, Jeong CW, Kwak C, Kim HH. The prognostic value of pretreatment of systemic inflammatory responses in patients with urothelial carcinoma undergoing radical cystectomy. Br J Cancer. 2015;112:461-7.
20. 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. Surg Oncol. 2014;23:31-9.
21. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436-44.
22. Aydin M, Bitkin A, Kadihasanoglu M, et al. Correlation of neutrophil-lymphocyte ratio and risk scores in non-muscle invasive bladder cancer. Actas Urol Esp. 2019;43:503-8.
23. 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;66:1157-64.
24. Can C, Baseskioglu B, Yilmaz M, Colak E, Ozen A, Yenilmez A. Pretreatment Parameters Obtained from Peripheral Blood Sample Predicts Invasiveness of Bladder Carcinoma. Urologia Internationalis. 2012;89:468-72.
25. 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-Seminars and Original Investigations. 2014;32:631-6.
26. Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK. Preoperative Neutrophil/Lymphocyte Ratio Predicts Overall Survival and Extravesical Disease in Patients Undergoing Radical Cystectomy. Journal of Endourology. 2013;27:1046-50.
27. 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. Int Braz J Urol. 2016;42:685-93.
28. 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? Kaohsiung Journal of Medical Sciences. 2016;32:327-33.
29. Racioppi M, Di Gianfrancesco L, Ragonese M, Palermo G, Sacco E, Bassi PF. Can Neutrophil-to-Lymphocyte ratio predict the response to BCG in high-risk non muscle invasive bladder cancer? International Braz J Urol. 2019;45:315-24.
30. 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;14:473-84.
- Abstract Viewed: 0 times
- 6765/pdf Downloaded: 0 times