Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-05-21

AUTHORS

Mihai Dorin Vartolomei, Romain Mathieu, Vitaly Margulis, Jose A. Karam, Morgan Rouprêt, Ilaria Lucca, Aurélie Mbeutcha, Christian Seitz, Pierre I. Karakiewicz, Harun Fajkovic, Christopher G. Wood, Alon Z. Weizer, Jay D. Raman, Nathalie Rioux-Leclercq, Andrea Haitel, Karim Bensalah, Michael Rink, Alberto Briganti, Evanguelos Xylinas, Shahrokh F. Shariat

ABSTRACT

ObjectiveSeveral retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort.MethodsPreoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models.ResultsAltered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03).ConclusionIn UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy. More... »

PAGES

121-130

References to SciGraph publications

Journal

TITLE

World Journal of Urology

ISSUE

1

VOLUME

35

Author Affiliations

  • Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania
  • Department of Urology, Rennes University Hospital, Rennes, France
  • Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
  • Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
  • Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
  • Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
  • Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
  • Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
  • Department of Urology, University of Michigan Cancer Center, Ann Arbor, MI, USA
  • Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
  • Department of Pathology, Rennes University Hospital, Rennes, France
  • Department of Pathology, Medical University of Vienna, Vienna, Austria
  • Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Department of Urology, Vita Salute San Raffaele University, Milan, Italy
  • Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
  • Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00345-016-1848-9

    DOI

    http://dx.doi.org/10.1007/s00345-016-1848-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1033799517

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27209168


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