title: Validation of the pretreatment derived neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma.
abstract: BACKGROUND
  The value of a combined index of neutrophil and white cell counts, named derived neutrophil-lymphocyte ratio (dNLR), has recently been proposed as a prognosticator of survival in various cancer types. We investigated the prognostic role of the dNLR in a large European cohort of patients with upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Data from 171 non-metastatic UTUC patients, operated between 1990 and 2012 at a single tertiary academic centre, were evaluated retrospectively. Cancer-specific- (CSS) as well as overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the dNLR, multivariate proportional Cox-regression models were applied. Additionally, the influence of the dNLR on the predictive accuracy of the multivariate model was further determined by Harrell's concordance index (c-index).
  
  
  RESULTS
  The median follow-up period was 31 months. An increased dNLR was statistically significantly associated with shorter CSS (log-rank P=0.004), as well as with shorter OS (log-rank P=0.002). Multivariate analysis identified dNLR as an independent predictor for CSS (hazard ratio, HR=1.16, 95% confidence interval, CI=1.01-1.35, P=0.045), as well as for OS (HR=1.21, 95% CI=1.09-1.34, P<0.001). The estimated c-index of the multivariate model for OS was 0.68 without dNLR and 0.73 when dNLR was added.
  
  
  CONCLUSIONS
  Patients with a high pretreatment dNLR could be predicted to show subsequently higher cancer-specific- as well as overall mortality after surgery for UTUC compared with those with a low pretreatment dNLR. Thus, this combined index should be considered as a potential prognostic biomarker in future.
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria.
authors.forename: O
authors.initials: O
authors.lastname: Dalpiaz
authors.affiliation: 1] Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria [2] Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, 1901 East Road, Houston, TX 77054, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pichler
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Mannweiler
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria.
authors.forename: J M
authors.initials: JM
authors.lastname: Martín Hernández
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Pummer
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria.
authors.forename: G C
authors.initials: GC
authors.lastname: Hutterer
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009504:Neutrophils; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery