Neutrophil-to-lymphocyte ratio as biomarker for predicting locally advanced disease and survival in patients treated with radical cystectomy

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

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Impact of Salvage Cytotoxic Chemotherapy on Prognosis in Patients with Recurrence After Radical Cystectomy: A Multi-Institutional Retrospective Study

10.21203/rs.3.rs-1137188/v1 ◽

2022 ◽

Author(s):

Dai Koguchi ◽

Kazumasa Matsumoto ◽

Masaomi Ikeda ◽

Yoshinori Taoka ◽

Takahiro Hirayama ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Liver Metastasis ◽

Radical Cystectomy ◽

Treatment Effect ◽

Advanced Disease ◽

Locally Advanced ◽

Cytotoxic Chemotherapy ◽

Locally Advanced Disease ◽

Clinicopathologic Factors

Abstract Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR: 1.92; 95% CI: 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

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The prognostic role of neutrophil-to-lymphocyte ratio trends during therapy in esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.17 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 17-17 ◽

Cited By ~ 1

Author(s):

Yaseen Al Lawati ◽

Jose Luis Ramirez-Garcialuna ◽

Juan Carlos Molina Franjola ◽

Donavan Pham ◽

Elena Skothos ◽

...

Keyword(s):

Esophageal Adenocarcinoma ◽

Cancer Progression ◽

Advanced Disease ◽

Locally Advanced ◽

Disease Free Survival ◽

Neutrophil To Lymphocyte Ratio ◽

Oncologic Outcomes ◽

Prognostic Role ◽

Lymphocyte Ratio

17 Background: Neutrophil-to-lymphocyte ratio (NLR) has been identified as a biomarker for a number of malignancies, with higher ratios being associated with poorer oncologic outcomes. Rather than purely an indicator of advanced disease there is emerging evidence that neutrophils are directly implicated in facilitating cancer progression, and thus alterations and trends of neutrophil counts and NLR during different phases of treatment may reflect a change in oncologic outcome that is as important, or more so, as the absolute count or NLR at baseline. The aim of this study is to investigate the prognostic role of neutrophil-to-lymphocyte ratio trends during the treatment trajectory of patients with esophageal adenocarcinoma. Methods: This is a retrospective study of patients who underwent esophagectomy for esophageal adenocarcinoma between 2005-2016. NLR was measured at three time points: baseline, during neoadjuvant chemotherapy (NAC), and in the late postoperative period. Primary outcomes were overall (OS) and disease-free survival (DFS). Results: 333 patients met our inclusion criteria. Mean age was 65.6 years and 82% of patients were males. The majority of patients had locally advanced disease; 75% had clinical T3 disease and 59% had clinical N-positive disease. NAC was administered in 65.6% of patients. Increasing NLR trends between baseline and late postoperative periods was associated with worse OS (3-year OS 56.1% vs. 71.9%, p=0.045). Patients in the high NLR group before and after treatment did worse than those who moved from high to low groups (3-year OS 42.8% vs. 69.2%, p=<0.0001, 3-year DFS 32.3% vs. 61.8%, p=0.0001). High NLR at baseline and in the postoperative stage is associated with worse OS (3-year OS: 57% vs. 75.7% for baseline and 44.1% vs. 74.9% for postoperative NLR; p=0.0038 and <0.0001, respectively) and DFS (3-year DFS: 52.4% vs. 60.9% for baseline and 34.9% vs. 59.9% for postoperative NLR; p=0.03 and <0.0001, respectively). Patients with complete pathological response to NAC had lower mean baseline NLR (3.2 vs. 4.9 p=0.009). Conclusions: Changes in NLR during treatment may provide a clearer picture about survival outcomes and the role of neutrophils in cancer progression.

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Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

Canadian Urological Association Journal ◽

10.5489/cuaj.245 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 699 ◽

Cited By ~ 25

Author(s):

Yannick Cerantola ◽

Massimo Valerio ◽

Aida Kawkabani Marchini ◽

Jean-Yves Meuwly ◽

Patrice Jichlinski

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Advanced Disease ◽

Locally Advanced ◽

Resonance Imaging ◽

Extracapsular Extension ◽

Predictive Values ◽

Locally Advanced Disease ◽

Multiparametric Magnetic Resonance Imaging

Background: Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension.Methods: We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomywere performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference.Results: Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively.Interpretation: This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

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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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