Prognostic Value of Neutrophil-to-lymphocyte Ratio and Establishment of Novel Preoperative Risk Stratification Model in Bladder Cancer Patients Treated With Radical Cystectomy

Introduction. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proven to be significant prognostic factors in many cancers. We aimed to retrospectively investigate the prognostic value of NLR and PLR in patients with bladder cancer undergoing radical cystectomy. Materials and Methods. The study comprised patients from 2010 to 2018 who were diagnosed with bladder cancer and received radical cystectomy. Clinical and pathological parameters were collected. Receiver operating characteristic curves of NLR and PLR were plotted for overall survival (OS) and cancer-specific survival (CSS). The best cutoff value of NLR and PLR were determined using X-tile software. The prognostic value of NLR and PLR for OS and CSS was analyzed using the Kaplan–Meier method and Cox regression models. Results. A total of 223 patients were enrolled with a medium follow-up period of 57 months. Receiver operating characteristic curves showed that PLR was superior to NLR as a prognostic factor in patients with bladder cancer undergoing radical cystectomy. Univariate analysis revealed that NLR (p=0.032 and p=0.041) and PLR (p=0.003 and p=0.003) were significantly associated with both OS and CSS, respectively. Multivariate analysis identified only PLR as independent prognostic factors for OS (p=0.046) and CSS (p=0.039), respectively. Conclusions. The present findings suggested that compared with NLR, PLR was a superior prognostic factor of OS and CSS in bladder cancer patients indicated to radical cystectomy.

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Integration of neutrophil-to-lymphocyte ratio into the MD Anderson Cancer Center preoperative risk classification of patients with bladder cancer who underwent radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(18)31404-0 ◽

2018 ◽

Vol 17 (2) ◽

pp. e820

Author(s):

Y. Hirasawa ◽

Y. Ishizawa ◽

T. Gondo ◽

Y. Shimizu ◽

T. Hashimoto ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Risk Classification ◽

Neutrophil To Lymphocyte Ratio ◽

Cancer Center ◽

Preoperative Risk ◽

Lymphocyte Ratio ◽

Md Anderson

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Prognostic impact of preoperative hematological disorders and a risk stratification model in bladder cancer patients treated with radical cystectomy

International Journal of Urology ◽

10.1111/iju.12161 ◽

2013 ◽

Vol 21 (1) ◽

pp. 52-57 ◽

Cited By ~ 18

Author(s):

Takehiro Sejima ◽

Shuichi Morizane ◽

Akihisa Yao ◽

Tadahiro Isoyama ◽

Motoaki Saito ◽

...

Keyword(s):

Bladder Cancer ◽

Risk Stratification ◽

Cancer Patients ◽

Radical Cystectomy ◽

Prognostic Impact ◽

Hematological Disorders ◽

Risk Stratification Model

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Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

Frontiers in Oncology ◽

10.3389/fonc.2021.762470 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yidi Wang ◽

Keyi Wang ◽

Jinliang Ni ◽

Houliang Zhang ◽

Lei Yin ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Roc Curves ◽

Neutrophil To Lymphocyte Ratio ◽

Postoperative Survival ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

T Stage

BackgroundInflammation is widely considered an important hallmark of cancer and associated with poor postoperative survival. The objective of this study is to assess the significance of preoperative C-NLR, a new inflammation-based index that includes preoperative C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), on therapeutic outcomes for bladder cancer (BC) patients after radical cystectomy (RC).Materials and MethodsBC patients who underwent RC between 2010 and 2019 were retrospectively analyzed from our medical center. The predictive effect of CRP, NLR, and C-NLR on the survival of BC patients were analyzed by the receiver operating characteristic (ROC) curves. The relationship between C-NLR and postoperative survival was investigated by Cox regression. The corresponding nomograms were built based on the Cox regression results of overall survival (OS) and disease-free survival (DFS), which were further validated by ROC curves, decision curve analysis (DCA) curves, and calibration curves.ResultsOf the 199 eligible patients, 83 (41.70%) were classified as high C-NLR group and the remaining 116 (58.30%) were classified as low C-NLR group. ROC analysis showed that C-NLR had the largest area under curve (AUC) compared to CRP and NLR. Multivariate analysis revealed that T-stage and C-NLR [high C-NLR vs. low C-NLR, hazard ratio (HR) = 2.478, 95% confidence interval (CI), 1.538–3.993, p < 0.001] were independent predictors of OS, whereas T-stage, M-stage, and C-NLR (high C-NLR vs. low C-NLR, HR = 2.817, 95% CI, 1.667–4.762, p < 0.001) were independent predictors of DFS. ROC and DCA analysis demonstrated better accuracy and discrimination of 3- and 5-year OS and DFS with C-NLR-based nomogram compared to TNM stage. The calibration curve reconfirmed the accurate predicting performance of nomograms.ConclusionC-NLR is a reliable predictor of long-term prognosis of BC patients after RC and will contribute to the optimization of individual therapy for BC patients.

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