Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non-muscle-invasive Bladder Cancer.
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Vartolomei Mihai Dorin, Ferro Matteo, Cantiello Francesco, Lucarelli Giuseppe, Di Stasi Savino, Hurle Rodolfo, Guazzoni Giorgio, Busetto Gian Maria, De Berardinis Ettore, Damiano Rocco, Perdona Sisto, Verze Paolo, La Rocca Roberto, Borghesi Marco, Schiavina Riccardo, Brunocilla Eugenio, Almeida Gilberto L, Bove Pierluigi, Lima Estevao, Grimaldi Giovanni, Autorino Riccardo, Crisan Nicolae, Abu Farhan Abdal Rahman, Battaglia Michele, Serretta Vincenzo, Russo Giorgio Ivan, Morgia Giuseppe, Terracciano Daniela, Musi Gennaro, de Cobelli Ottavio, Mirone Vincenzo, Shariat Shahrokh F
Аннотация
PATIENTS AND METHODS: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS).
RESULTS: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%).
CONCLUSIONS: Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.