Can Neutrophil-to-Lymphocyte ratio predict the response to BCG in high-risk non muscle invasive bladder cancer?

BACKGROUND Bacillus Calmette-Guérin (BCG) is currently the most clinically effective intravesical treatment for non–muscle-invasive bladder cancer (NMIBC), particularly for patients with high-risk NMIBC such as those with carcinoma in-situ (CIS). BCG treatments could be optimized to improve patient safety and conserve supply by predicting BCG efficacy with tumor characteristics or clinicopathological criteria. OBJECTIVE To assess the ability of specific clinicopathological criteria to predict tumor recurrence in patients with NMIBC who received BCG along various treatment timelines. METHODS A total of 1331 patients (Stage Ta, T1, or CIS) who underwent transurethral resection of a bladder tumor (TUR) between 2006 and 2017 were included. Univariate analysis including laboratory tests (e.g. complete blood panels, creatinine levels, Hemoglobin A1c levels) within 180 days post-BCG therapy initiation, medications, and clinical and demographic variables to assess their ability to predict NMIBC recurrence was completed. This was followed by multivariate regression that included the elements of Club Urológico Español de Tratamiento Oncológico (CUETO) and variables that were significant predictors of recurrence in univariate analysis. RESULTS BCG was administered to 183 intermediate- or high-risk patients, and 76 (41.5%) experienced disease recurrence. Abnormal neutrophil-to-lymphocyte ratio measured within 180 days post-induction BCG was a significant predictor (p<0.05) of future cancer recurrence and was a stronger predictor than CUETO or the individual variables included in CUETO via multivariate analysis. CONCLUSIONS Abnormal neutrophil-to-lymphocyte ratio within 180 days following BCG is predictive of recurrence and could be a suggestive for additional or alternative interventions. CLINICALTRIAL N/A

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Neutrophil-to-Lymphocyte Ratio: A new prognostic factor in high risk non muscle invasive bladder cancer treated with BCG?

European Urology Supplements ◽

10.1016/s1569-9056(18)32480-1 ◽

2018 ◽

Vol 17 (4) ◽

pp. e2078 ◽

Cited By ~ 1

Author(s):

L. Di Gianfrancesco ◽

M. Racioppi ◽

M. Ragonese ◽

G. Palermo ◽

E. Sacco ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Prognostic Factor ◽

Neutrophil To Lymphocyte Ratio ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Lymphocyte Ratio ◽

Muscle Invasive

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Easily Available Blood Test Neutrophil-To-Lymphocyte Ratio Predicts Progression in High-Risk Non-Muscle Invasive Bladder Cancer

Revista Romana de Medicina de Laborator ◽

10.1515/rrlm-2017-0016 ◽

2017 ◽

Vol 25 (2) ◽

Cited By ~ 2

Author(s):

Orsolya Martha ◽

Daniel Porav-Hodade ◽

Daniel Bălan ◽

Octavian Sabin Tătaru ◽

Anca Sin ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Prognostic Factor ◽

Clinical Decision Making ◽

Neutrophil To Lymphocyte Ratio ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Lymphocyte Ratio ◽

Muscle Invasive

AbstractIntroduction: The inflammatory response surrounding the tumour has a major importance in the oncologic outcome of bladder cancers. One marker proved to be useful and accessible is NLR (neutrophil-to-lymphocyte ratio). The objective of the study was the analysis of NLR as a prognostic factor for recurrence and progression in pT1a and pT1b bladder cancers.Material and Methods: Retrospective study, with 44 T1a/T1b bladder cancer patients. Each patient underwent transurethral resection. NLR was considered altered if higher than 3, average follow-up period was of 18 months.Results: The mean age of the patients included was 73 years (IQR 64 - 77). Most of the patients had NLR<3 (30 patients). In total 29/44 (65.9 %) patients presented recurrence and 15/44 (34.1 %) patients were identified with T2 or higher stage progression during the follow-up period (average 18 months).We found no statistically significant association between NLR>3 and other clinic and pathologic factors. Progression-free survival (PFS) Kaplan-Meier analysis showed a lower PFS in the NLR>3 group, with a p=0.001 value. A total of 64.3% of patients had shown progression in the NLR>3 group and 20% in the NLR<3 group. Mean NLR was 2.67 (IQR 1.88-3.5); 2.50 (IQR 1.89-2.87) in patients that did not present any progression during the follow-up and 3.20 (IQR 1.73-5.80) in those with progression (p=0.09), ROC 0.655. Mean NLR was 2.14 (IQR 1.61-2.77) in patients that did not experience a recurrence during the follow-up and 2.76 (IQR 2.1-4.31) in those with recurrence, ROC 0.671 (p=0.06). Multivariable Cox regression analyses showed that stage T1b and NLR represent independent prognostic factors for PFS.Conclusion: High Neutrophil-to-Lymphocyte ratio retained a statistically significant value, as an independent prognostic factor for bad prognosis of T1 bladder tumors. NLR represents a biomarker that could support a clinical decision making in case of high-risk on-muscle invasive bladder cancer.

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