The Clinical Use of the Neutrophil to Lymphocyte Ratio (NLR) in Urothelial Cancer: A Systematic Review

• Published in: Clinical genitourinary cancer Vol. 14; no. 6; pp. 473 - 484
• Main Authors: Marchioni, Michele, Primiceri, Giulia, Ingrosso, Manuela, Filograna, Roberta, Castellan, Pietro, De Francesco, Piergustavo, Schips, Luigi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016
• Subjects: Bladder cancer; Carcinoma, Transitional Cell - blood; Carcinoma, Transitional Cell - pathology; Hematology, Oncology and Palliative Medicine; Humans; Leukocyte Count; Lymphocyte Count; Neutrophil to lymphocyte ratio; Oncologic outcome; Prognosis; Prognostic value; Survival Analysis; Upper tract urothelial cancer; Urinary Bladder Neoplasms - blood; Urinary Bladder Neoplasms - pathology; Urology; Prognostic value; Oncologic outcome; Bladder cancer; Neutrophil to lymphocyte ratio; Upper tract urothelial cancer
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2016.04.008

The neutrophil to lymphocyte ratio (NLR) is an inflammatory index that has been considered as a potential prognostic factor in human cancer. The aim of this study was to evaluate the available evidence regarding the NLR as a prognostic value in patients affected by urothelial cancer. This literature review, including papers on NLR in urothelial cancers, was done on PubMed/Medline and Cochrane libraries in November 2015. The selection of the articles followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Twenty-three of 99 articles fulfilled all the inclusion criteria, including data on 6240 patients affected by urothelial cancers. Overall, cancer-specific, and recurrence-free survival were evaluated as the main oncological outcomes. There was significant heterogeneity among studies, and the majority of studies were of poor quality. Overall, NLR was considered as a prognostic marker in 87.5%, 80%, and 60% of the studies on upper tract urothelial cancer, urothelial bladder cancer, and metastatic and advanced disease, respectively. The NLR cut-off value ranged between 2 and 5. A high NLR was associated with worse overall, cancer-specific, and recurrence-free survival. NLR is a widely available, easy-to-collect, costless, prognostic marker in urothelial cancers. Its clinical use still remains under investigation, especially for the need for cut-off values, particularly in different subsets of patients.