High Neutrophil-to-lymphocyte Ratio Persistent During First-line Chemotherapy Predicts Poor Clinical Outcome in Patients with Advanced Urothelial Cancer

• Published in: Annals of surgical oncology Vol. 22; no. 4; pp. 1377 - 1384
• Main Authors: Rossi, Lorena, Santoni, Matteo, Crabb, Simon J., Scarpi, Emanuela, Burattini, Luciano, Chau, Caroline, Bianchi, Emanuela, Savini, Agnese, Burgio, Salvatore L., Conti, Alessandro, Conteduca, Vincenza, Cascinu, Stefano, De Giorgi, Ugo
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Clinical outcomes; Female; Follow-Up Studies; Humans; Lymphocytes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neutrophils - pathology; Oncology; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urologic Oncology; Visceral Metastasis; Urothelial Cancer; Overall Survival; Median Overall Survival; Eastern Cooperative Oncology Group
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4097-4

Background Increased neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation, is associated with poor outcome for various types of cancers. We assessed the role on outcome prediction of NLR at baseline and persistent during first-line chemotherapy in patients with advanced urothelial cancer. Methods We retrospectively reviewed 292 patients with unresectable or metastatic urothelial cancer treated with first-line chemotherapy between January 2003 and December 2012. The cutoff values of NLR (>3 vs. <3) were evaluated before therapy and at day 1 of the second and third cycle (follow-up NLR). After univariate analysis, a multivariate analysis was carried out by Cox regression model and included the following variables: Eastern Cooperative Oncology Group (ECOG) performance status (≥2 vs. 0–1), visceral disease (present vs. absent), hemoglobin (<12 g/dL vs. >12 g/dL), pretherapy NLR (>3 vs. <3), and follow-up NLR (>3 vs. ≤3). Results Patients with pre- and follow-up NLR of >3 had a median progression-free survival of 3.2 months and a median overall survival of 5.7 months. In multivariate analysis, visceral metastases, pretherapy hemoglobin, and follow-up NLR were significant predictors of progression-free survival [hazard ratio (HR) 1.75, P  = 0.0001; HR 1.57, P  = 0.0015; HR 2.77, P  < 0.0001, respectively], and of overall survival (HR 1.60, P  = 0.0023; HR 1.59, P  = 0.0024; HR 2.89, P  < 0.0001, respectively); whereas pretherapy NLR remained as predictor of overall survival only (HR 1.53, P  = 0.0101). Conclusions An increased NLR persistent during first-line chemotherapy is an independent predictive factor for patients with advanced urothelial cancer.