A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

• Published in: Annals of surgical oncology Vol. 21; no. 12; pp. 4041 - 4048
• Main Authors: Tanaka, Nobuyuki, Kikuchi, Eiji, Kanao, Kent, Matsumoto, Kazuhiro, Shirotake, Suguru, Miyazaki, Yasumasa, Kobayashi, Hiroaki, Kaneko, Gou, Hagiwara, Masayuki, Ide, Hiroki, Obata, Jun, Hoshino, Katsura, Hayakawa, Nozomi, Kosaka, Takeo, Hara, Satoshi, Oyama, Masafumi, Momma, Tetsuo, Nakajima, Yosuke, Jinzaki, Masahiro, Oya, Mototsugu
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-11-2014; Springer Nature B.V
• Subjects: Aged; Biomarkers, Tumor - analysis; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Female; Follow-Up Studies; Humans; Lymphocytes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Nephrectomy; Neutrophils - pathology; Oncology; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Ureter - surgery; Urologic Neoplasms - mortality; Urologic Neoplasms - pathology; Urologic Neoplasms - surgery; Urologic Oncology; Predict Disease Recurrence; Subsequent Disease Recurrence; Urothelial Carcinoma; Urothelial Carcinoma Patient; Radical Nephroureterectomy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3830-3

Background
To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).
Methods
A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.
Results
Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (
p

<
 0.001) and 60.2 % (
p

<
 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (
p

=
 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (
p

=
 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (
p

=
 0.041) and 83.0 % (
p

=
 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).
Conclusion
This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.