title: NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To evaluate the ability of preoperative neutrophil-lymphocyte ratio (NLR) to predict pathologic upstaging and nonorgan-confined (NOC) (≥pT3) disease.
  
  
  METHODS
  After institutional review board approval, the records of consecutive patients undergoing radical cystectomy (RC) for urothelial carcinoma from 2002 to 2012 at the University of Wisconsin Hospital were reviewed. A total of 102 patients with NLR within 100 days of surgery were eligible for analysis. The primary outcome was difference in stage from preoperative assessment to time of RC. Differences in preoperative NLR between groups were evaluated with an unequal variance t test. A univariate analysis assessed whether NLR, preoperative stage, grade, associated lymphovascular invasion, preoperative hydronephrosis, gender, previous pelvic radiotherapy, previous intravesical bladder cancer treatments, or nodal stage were related to upstaging. Multivariate analyses were performed to evaluate the relationship of NLR to upstaging and relative organ-confined (≤pT2) and NOC disease.
  
  
  RESULTS
  Of 390 consecutive patients undergoing RC, 102 patients met study criteria. Overall, 55 (53.9%) patients were upstaged, 25 (25.5%) were unchanged, and 21 (20.6%) were downstaged. Fifty-one patients (50%) were upstaged to more advanced disease (≥pT3). NLR and preoperative hydronephrosis were significantly related to pathologic tumor staging. NLR, preoperative hydronephrosis, and preoperative tumor stage were significantly related to upstaging to NOC disease. Patients who were upstaged to≥pT3 demonstrated statistically significant greater NLRs (4.33±0.87) compared with patients who remained at≤pT2 stage (2.66±0.29) (P<0.001).
  
  
  CONCLUSIONS
  Preoperative NLR is a simple measurement that can be used to identify high-risk patients who may be upstaged at the time of RC and may benefit from neoadjuvant chemotherapy.
authors.affiliation: Department of Urology, University of Wisconsin, Madison, WI. Electronic address: apotretzke@uwhealth.org.
authors.forename: Aaron
authors.initials: A
authors.lastname: Potretzke
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Luke
authors.initials: L
authors.lastname: Hillman
authors.affiliation: Department of Urology, University of Wisconsin, Madison, WI.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Wong
authors.affiliation: Department of Urology, University of Wisconsin, Madison, WI.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Shi
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brower
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mai
authors.affiliation: University of Wisconsin Carbone Cancer Center, Madison, WI.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Cetnar
authors.affiliation: Department of Urology, University of Wisconsin, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI.
authors.forename: Edwin Jason
authors.initials: EJ
authors.lastname: Abel
authors.affiliation: Department of Urology, University of Wisconsin, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI.
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Downs
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000097:blood* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D009504:Neutrophils / Q000166:cytology; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*
keywords: Bladder cancer; Lymphocyte; Neoadjuvant chemotherapy; Neutrophil; Upstaging