title: Clinical significance of prognosis using the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil-lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0-22 mm/h in men and 0-27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I, n = 169), and those with both elevated ESR and elevated NLR (group II, n = 73).
  
  
  RESULTS
  The median patient age was 64 years and the median follow-up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLRs and ESRs, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status (P < 0.05). Preoperative ESR (hazard ratio [HR] 1.784, 95% confidence interval [CI] 1.173-2.712), NLR (HR 1.704, 95% CI 1.136-2.556), and prognostic grouping (HR 2.285, 95% CI 1.397-3.737 for group I; HR 2.962, 95% CI 1.719-5.102 for group II) were independent predictors of progression-free survival (PFS) in the multivariate model (P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS). Time-dependent area under the receiver-operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes (P < 0.05).
  
  
  CONCLUSIONS
  Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC. The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun Hwan
authors.initials: HH
authors.lastname: Sung
authors.forename: Hwang Gyun
authors.initials: HG
authors.lastname: Jeon
authors.forename: Byong Chang
authors.initials: BC
authors.lastname: Jeong
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Han-Yong
authors.initials: HY
authors.lastname: Choi
authors.forename: Hyun Moo
authors.initials: HM
authors.lastname: Lee
mesh_terms: D000368:Aged; D001799:Blood Sedimentation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D014571:Urologic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D019459:Urothelium / Q000473:pathology
keywords: erythrocyte sedimentation rate; neutrophil-lymphocyte ratio; upper urinary tract; urothelial carcinoma