Baseline neutrophil to lymphocyte ratio as a prognostic marker for patients with muscle-invasive bladder cancer being treated with neoadjuvant chemotherapy.

468 Background: The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, has been associated with a poor prognosis in several solid malignancies. In muscle-invasive bladder cancer (MIBC), an elevated pre-cystectomy NLR has been shown to predict for poor survival; however, its role in prognostication for patients being treated with neoadjuvant chemotherapy (NAC) is unknown. We evaluated the baseline NLR as an independent prognostic factor in patients with MIBC treated with NAC. Methods: Patients with MIBC treated with NAC in Alberta from 2005 to 2015, and at the Princess Margaret Hospital in Ontario from 2005 to 2013 were evaluated. All 290 patients treated with NAC were included; 272 were evaluable for NLR and outcomes. Patient, disease, and treatment-related factors were evaluated. NLR was examined prior to initiation of preoperative chemotherapy. The prognostic role of NLR on overall survival (OS) and progression-free survival (PFS) was determined using Cox proportional hazard regression analysis. Results: The median age of patients was 66 years (range 36-87). The majority of patients (77%) were male. Median baseline NLR at diagnosis was 2.9. NLR > 3.0 at baseline was independently associated with PFS and OS after adjustment for age, gender and stage (Table). Patients with an NLR > 3 had a median PFS of 14.1 months compared to 25.1 months in those patients with a baseline NLR ≤ 3 (HR 0.63, p = 0.01). Similarly, OS was 19.4 months in patients with a baseline NLR > 3 compared to 33.4 months in those with a baseline NLR ≤ 3 (HR 0.65, p = 0.04). Conclusions: NLR is an independent prognostic factor for patients with MIBC undergoing NAC. [Table: see text]