title: Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy.
abstract: OBJECTIVE
  Preoperative prognostic factors in bladder cancer patients have not been fully established. This study was undertaken to investigate preoperative prognostic factors, including neutrophil-to-lymphocyte ratio (NLR), and to develop a novel prognostic factors-based risk stratification model for disease-specific survival (DSS) in bladder cancer patients treated with radical cystectomy (RC).
  
  
  METHODS
  We performed a retrospective analysis of 189 consecutive bladder cancer patients treated with RC at our institution. Prognostic value of the preoperative clinical and laboratory parameters were evaluated by univariate and multivariate Cox proportional hazard model analyses, and patients were stratified according to relative risks (RRs) for DSS.
  
  
  RESULTS
  One-, 3-, and 5-year DSS rates were 86.8%, 70.8%, and 61.7%, respectively. In univariate analysis, tumor size, clinical T stage, hydronephrosis, concomitance of carcinoma in situ, and some laboratory findings (hemoglobin [Hb] level, platelet count, C-reactive protein, neutrophil count, lymphocyte count, and NLR) were significantly associated with poor prognosis. In multivariate analysis, tumor size, hydronephrosis, Hb level, and NLR were independent factors for predicting poor prognosis. Patients were stratified into 3 risk groups: low (RR = 1.000-3.717), intermediate (RR = 4.149-9.315), and high (RR = 10.397-38.646). The differences among the groups were significant.
  
  
  CONCLUSIONS
  NLR was an independent prognostic factor, as were tumor size, hydronephrosis, and Hb levels, and the combination of these factors can stratify DSS risks in bladder cancer patients treated with RC. This information may be useful for identifying patients who might be candidates for clinical trials of multimodal treatment strategies, including innovative neoadjuvant treatments.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.forename: Jun
authors.initials: J
authors.lastname: Nakashima
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohno
authors.forename: Ozu
authors.initials: O
authors.lastname: Choichiro
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Horiguchi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Namiki
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohori
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hatano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002278:Carcinoma in Situ / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein