奇美醫院 外科部 泌尿科1，病理部2；台北馬偕醫院 泌尿科4
Validation of Neutrophil to Lymphocyte Ratio for Prognosis and Treatment Selection in Muscle Invasive Bladder Cancer: A Single-Institutional Longitudinal Study
Sheng-Min Tsai1、Wen-Hsin Tseng1、Steven K. Huang1、Chien-Feng Li2、Allen W.Chiu3
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
2Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
3Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Radical cystectomy (RC) and bladder-sparing tri-modal therapy (TMT) are two broad categories of primary definitive treatment for muscle invasive bladder cancer (MIBC). Similar outcomes and efficacy rates have been reported for RC and TMT. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a biomarker for cancer prognosis. The aim of this study was to investigate the prognostic role of the NLR in patients with MIBC and the potential for validation of its role in the selection of appropriate treatment.
Material and Methods: We retrospectively analyzed 207 patients who were pathologically diagnosed with muscle invasive bladder cancer at the Chi Mei Medical Center between January 2012 and December 2018. We excluded patients with metastasis disease, those who received other treatments, who were lost to follow-up, and lacked pre-operative data and infection. In total, 116 patients who received RC or TMT were enrolled and categorized into high NLR vs. low NLR groups. The cut-off point was determined by ROC curve analysis. The outcomes of interest included disease-free survival (DFS) and overall survival (OS) rates. The risk factors for recurrence and survival were assessed using Cox regression models.
Results: The study sample comprised 87 men and 29 women (mean age, 67.7 ± 10.8 years). The NLR cut-off point was 2.70 for recurrence and death, with an area under the ROC of 0.586 and 0.645, respectively. In total, 64 patients had an NLR≦2.7 and 52 patients had an NLR >2.7. When compared to the low NLR group, the high NLR group was older (65.6 vs. 70.4, p=0.003) and had a higher recurrence rate (43.8% vs. 55.80%, p = 0.025) and mortality rate (29.7% vs. 50%, p = 0.005). Better DFS of RC was observed in the high NLR group (log-rank test: p = 0.046). There were no statistically significant associations with outcome in the low NLR group. In the Cox regression model, advanced tumor staging was a strong risk factor for poor recurrence and survival. In the high NLR group, mortality was associated with smoking (Hazard Ratio (HR) = 4.15, p = 0.023) and comorbidity (HR = 1.48, p = 0.004).
Conclusions: This study demonstrated the relevance of the NLR in the prediction of recurrence and mortality. We could only confirm an association with DFS in the high NLR group. Thus, the usefulness of the NLR in the validation of treatment selection remains doubtful.