title: Preoperative neutrophil-lymphocyte ratio as an independent prognostic marker for patients with upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  To predict the prognosis, we evaluated the significance of the preoperative neutrophil-lymphocyte ratio (NLR) in patients with upper urinary tract urothelial carcinoma (UUTUC).
  
  
  METHODS
  A cohort of 137 patients diagnosed with UUTUC from 1994 to 2008 at Tokyo Metropolitan Tama Medical Center was enrolled in this retrospective study. Log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses.
  
  
  RESULTS
  On univariate analysis, pathologic T stage, grade, lymphovascular invasion, C-reactive protein (CRP) level, and NLR were significantly associated with recurrence-free survival (RFS) and cancer-specific survival (CSS). The RFS rates for an NLR < 2.5 and for one ≥ 2.5 at 5 years were 74.3% and 30.4%, respectively. The CSS rates for an NLR < 2.5 and for one ≥ 2.5 at 5 years were 81.3% and 29.4%, respectively. The multivariate Cox proportional hazards regression models showed that the NLR could be an independent predictor for RFS and CSS. Based on the results of multivariate analysis, the scoring model was developed. RFS and CSS rates at 5 years were as follows: 0 risk factor, 97.1% and 97.0%, respectively; 1 risk factor, 91.1% and 90.9%, respectively; 2 risk factors, 39.5% and 58.6%, respectively; 3 risk factors, 26.6% and 28.6%, respectively; and 4 risk factors, 6.0% and 5.6%, respectively.
  
  
  CONCLUSIONS
  The preoperative NLR is an independent prognostic predictor. The model based on the NLR and pathologic factors can be useful in clinical practice.
authors.affiliation: Department of Urology, Tokyo Metropolitan Tama Medical Center, 2-9-2 Musashi-dai, Fuchu, Tokyo, Japan. azumamifune@yahoo.co.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Matayoshi
authors.forename: Keiko
authors.initials: K
authors.lastname: Odani
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Sato
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Sato
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagase
authors.forename: Masaya
authors.initials: M
authors.lastname: Oshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation / Q000276:immunology; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D009504:Neutrophils / Q000276:immunology*; D012189:Retrospective Studies; D014571:Urologic Neoplasms / Q000276:immunology* / Q000601:surgery*; D019459:Urothelium / Q000166:cytology / Q000473:pathology / Q000601:surgery
keywords: Neutrophil-lymphocyte ratio; Prognostic factors; Upper urinary tract urothelial carcinoma