title: Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To evaluate if hematologic parameters and inflammatory markers could predict extravesical tumor and overall survival after radical cystectomy for patients with recurrent high grade T1 or muscle-invasive bladder cancer.
  
  
  METHODS
  A total of 68 consecutive cases of radical cystectomy performed with curative intent at our institution between April 2005 and October 2011 with preoperative hematologic parameters are included in this analysis. We evaluated preoperative characteristics with univariable and multivariate Cox proportional hazard ratios to assist in risk stratification for overall survival. Relative risk (RR) ratios and 95% confidence intervals (CI) were created. We also identified factors associated with extravesical tumor extension with logistic regression analysis.
  
  
  RESULTS
  Median overall survival in the total cohort was 25 months (95% CI 13-61). In multivariate analysis, neutrophil/lymphocyte ratio <2.5 (RR 2.49; 95% CI 1.14-6.09), hypoalbuminemia (RR 4.96; 95% CI 2.18-11.67), pT3/4 (RR 7.97, 95% CI 3.16-24.83), and lymph node positive disease (RR 2.62, 95% CI 1.26-5.46) predicted overall survival. These were statistically significant for cancer-specific survival as well. Both elevated neutrophil/lymphocyte ratio (RR 3.18, 95% CI 1.09-9.79) and hypoalbuminemia (RR 3.72, 95% CI 1.12-15.00) were associated with risk for extravesical disease.
  
  
  CONCLUSIONS
  Serum neutrophil/lymphocyte ratio and hypoalbuminemia predict overall and cancer-specific survival in patients undergoing radical cystectomy for muscle-invasive bladder cancer. These parameters also predict risk for extravesical disease. These could be combined with other established preoperative parameters to improve risk stratification and preoperative counseling.
authors.affiliation: Department of Urology, Wake Forest University, Winston-Salem, North Carolina 27157-1094, USA.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.forename: A Karim
authors.initials: AK
authors.lastname: Kader
authors.forename: Ronald
authors.initials: R
authors.lastname: Davis
authors.forename: K C
authors.initials: KC
authors.lastname: Balaji
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness; D009504:Neutrophils / Q000473:pathology*; D009657:North Carolina / Q000453:epidemiology; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*