title: A multi-institutional validation of the prognostic value of the neutrophil-to-lymphocyte ratio for upper tract urothelial carcinoma treated with radical nephroureterectomy.
abstract: BACKGROUND
  To externally validate the prognostic impact of preoperative neutrophil-lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).
  
  
  METHODS
  A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.
  
  
  RESULTS
  Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (p < 0.001) and 60.2 % (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (p = 0.041) and 83.0 % (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).
  
  
  CONCLUSIONS
  This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Suguru
authors.initials: S
authors.lastname: Shirotake
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Gou
authors.initials: G
authors.lastname: Kaneko
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.forename: Jun
authors.initials: J
authors.lastname: Obata
authors.forename: Katsura
authors.initials: K
authors.lastname: Hoshino
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hara
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oyama
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Momma
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor