title: Subclassification of upper urinary tract urothelial carcinoma by the neutrophil-to-lymphocyte ratio (NLR) improves prediction of oncological outcome.
abstract: OBJECTIVE
  To examine the potential role of the neutrophil-to-lymphocyte ratio (NLR) for subclassification of localised upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  METHODS
  From 2004 to 2010, 234 patients with localised UUT-UC underwent radical nephroureterectomy (RNU). NLRs were only obtained under afebrile conditions before RNU. Patients that underwent neoadjuvant or adjuvant chemotherapy were excluded. The prognostic impact of the NLR was assessed using the log-rank test and multivariate analyses.
  
  
  RESULTS
  Only advanced pathological stage (>T2) and a NLR of >3 were independently associated with metastasis (P < 0.001 and P = 0.02, respectively) and cancer-specific mortality (P = 0.002 and P = 0.006, respectively). The use of a NLR of >3 further identified a poor prognostic group, especially in patients with T3 UUT-UC for metastasis-free survival and cancer-specific survival (log-rank test, both P < 0.001).
  
  
  CONCLUSIONS
  For localised UUT-UC, pathological stage and preoperative NLR independently predict systemic recurrence and cancer-specific death after RNU. Using the NLR for subclassification of T3 UUT-UC seems to further identify a poor prognostic group and may help with clinical decisions about treatment intervention in clinical practice.
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hao-Lun
authors.initials: HL
authors.lastname: Luo
authors.forename: Yen-Ta
authors.initials: YT
authors.lastname: Chen
authors.forename: Yao-Chi
authors.initials: YC
authors.lastname: Chuang
authors.forename: Yuan-Tso
authors.initials: YT
authors.lastname: Cheng
authors.forename: Wei-Ching
authors.initials: WC
authors.lastname: Lee
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Kang
authors.forename: Po-Hui
authors.initials: PH
authors.lastname: Chiang
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000145:classification*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000145:classification*; D008214:Lymphocytes; D008297:Male; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000097:blood* / Q000145:classification*
keywords: neutrophil to lymphocyte; upper urinary tract; urothelial carcinoma