Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non-muscle-invasive Bladder Cancer

Vincenzo Serretta, Michele Battaglia, Paolo Verze, Estevao Lima, Riccardo Autorino, Matteo Ferro, Riccardo Schiavina, Gennaro Musi, Gilberto L. Almeida, Marco Borghesi, Gian Maria Busetto, Roberto La Rocca, Mihai Dorin Vartolomei, Nicolae Crisan, Ettore De Berardinis, Rodolfo Hurle, Giorgio Ivan Russo, Giovanni Grimaldi, Abdal Rahman Abu Farhan, Marco BorghesiRoberto La Rocca, Francesco Cantiello, Daniela Terracciano, Eugenio Brunocilla, Sisto Perdona, Ottavio De Cobelli, Pierluigi Bove, Shahrokh F. Shariat, Savino Di Stasi, Giuseppe Morgia, Vincenzo Mirone, Giorgio Guazzoni, Rocco Damiano, Michele Battaglia, Giuseppe Lucarelli, Paolo Verze

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32 Citations (Scopus)


Neutrophil-to-lymphocyte ratio was found associated with worse disease recurrence and progression in patients with T1 non-muscle-invasive bladder cancer in some single-center studies. We validated high pretreatment neutrophil-to-lymphocyte ratio (cutoff, 3) as an independent predictor of disease recurrence, progression, and cancer-specific survival in patients with primary T1 HG/G3 non muscle-invasive bladder cancer treated with intravesical bacillus Calmette-Guerin therapy.Introduction: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/ G3 non-muscle-invasive bladder cancer (NMIBC). Patients and Methods: The study period was from January 2002 t hrough December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guerin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free PFS), overall (OS), and cancer-specific survival (CSS). Results: A total of 512 (48.9%) of patients had NLR > 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR >= 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P - .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (6.9%), PFS (1.8%), and CSS ( 1.7%). Conclusions: Pretreatment NLR >= 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up. (C) 2018 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)445-452
Number of pages8
JournalClinical Genitourinary Cancer
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology


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