title: High neutrophil-to-lymphocyte ratio persistent during first-line chemotherapy predicts poor clinical outcome in patients with advanced urothelial cancer.
abstract: BACKGROUND
  Increased neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation, is associated with poor outcome for various types of cancers. We assessed the role on outcome prediction of NLR at baseline and persistent during first-line chemotherapy in patients with advanced urothelial cancer.
  
  
  METHODS
  We retrospectively reviewed 292 patients with unresectable or metastatic urothelial cancer treated with first-line chemotherapy between January 2003 and December 2012. The cutoff values of NLR (>3 vs. <3) were evaluated before therapy and at day 1 of the second and third cycle (follow-up NLR). After univariate analysis, a multivariate analysis was carried out by Cox regression model and included the following variables: Eastern Cooperative Oncology Group (ECOG) performance status (≥ 2 vs. 0-1), visceral disease (present vs. absent), hemoglobin (<12 g/dL vs. >12 g/dL), pretherapy NLR (>3 vs. <3), and follow-up NLR (>3 vs. ≤ 3).
  
  
  RESULTS
  Patients with pre- and follow-up NLR of >3 had a median progression-free survival of 3.2 months and a median overall survival of 5.7 months. In multivariate analysis, visceral metastases, pretherapy hemoglobin, and follow-up NLR were significant predictors of progression-free survival [hazard ratio (HR) 1.75, P = 0.0001; HR 1.57, P = 0.0015; HR 2.77, P < 0.0001, respectively], and of overall survival (HR 1.60, P = 0.0023; HR 1.59, P = 0.0024; HR 2.89, P < 0.0001, respectively); whereas pretherapy NLR remained as predictor of overall survival only (HR 1.53, P = 0.0101).
  
  
  CONCLUSIONS
  An increased NLR persistent during first-line chemotherapy is an independent predictive factor for patients with advanced urothelial cancer.
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Rossi
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Crabb
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
authors.forename: Luciano
authors.initials: L
authors.lastname: Burattini
authors.forename: Caroline
authors.initials: C
authors.lastname: Chau
authors.forename: Emanuela
authors.initials: E
authors.lastname: Bianchi
authors.forename: Agnese
authors.initials: A
authors.lastname: Savini
authors.forename: Salvatore L
authors.initials: SL
authors.lastname: Burgio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.forename: Vincenza
authors.initials: V
authors.lastname: Conteduca
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*