title: Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer.
abstract: BACKGROUND
  We investigated the value of the preoperative neutrophil-lymphocyte ratio (NLR) in predicting recurrence and progression of high-grade pT1 non-muscle-invasive tumour in patients with bladder cancer during a 5-year follow-up period.
  
  
  METHODS
  We retrospectively reviewed data of 1100 patients with bladder cancer; these patients underwent transurethral resection and were monitored at multiple centres from 2008 to 2013. In total, 166 consecutive and newly diagnosed patients with high-grade pT1 tumours were included in this study. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count.
  
  
  RESULTS
  Of the 166 patients, 152 were male. The patients were evaluated as two separate groups in terms of recurrence and progression. The mean follow-up period was 24.2 months (interquartile range 13.8-36.6 months). A statistically significant difference was found between recurrence and tumour size (p = 0.001), number of tumours (p < 0.001), NLR (p < 0.001), and smoking (p = 0.007). No statistically significant correlation was found between NLR and progression. According to receiver operating characteristic (ROC) analysis, the optimum cut-off value for the NLR was ≥2.43 (74% sensitivity, 60% specificity, p < 0.001; area under the curve [AUC] 0.687, 95% confidence interval [CI] 0.607-0.767). Multivariate logistic regression analysis determined that the following factors were independent predictors of recurrence in patients with high-grade pT1 non-muscle-invasive bladder cancer: tumour number (OR 5.32, 95% CI 2.10-12.90), NLR of ≥2.43 (OR 2.587; 95% CI 1.156-5.789), and smoking (OR 4.17, 95% CI 1.31-13.21).
  
  
  CONCLUSIONS
  A high preoperative NLR may play an important role in predicting recurrence of superficial transitional cell type high-grade pT1 bladder tumours. Prospective studies are required to validate the role of NLR as a prognostic marker in high-grade pT1 bladder tumours.
authors.affiliation: Department of Urology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey;
authors.forename: Mehmet Emin
authors.initials: ME
authors.lastname: Ozyalvacli
authors.affiliation: Department of Pathology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey;
authors.forename: Gulzade
authors.initials: G
authors.lastname: Ozyalvacli
authors.affiliation: Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kocaaslan
authors.affiliation: Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey.
authors.forename: Kursat
authors.initials: K
authors.lastname: Cecen
authors.affiliation: Department of Urology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey;
authors.forename: Ugur
authors.initials: U
authors.lastname: Uyeturk
authors.affiliation: Department of Urology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey;
authors.forename: Eray
authors.initials: E
authors.lastname: Kemahlı
authors.affiliation: Department of Urology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey;
authors.forename: Adnan
authors.initials: A
authors.lastname: Gucuk
references.citation: Clin Cancer Res. 2010 Dec 1;16(23):5805-13
references.pmid: 20956618
references.citation: J Surg Oncol. 2011 Oct;104(5):504-10
references.pmid: 21618251
references.citation: Eur Urol. 2013 Feb;63(2):234-41
references.pmid: 22877502
references.citation: Cancer. 2012 May 1;118(9):2476-85
references.pmid: 21953023
references.citation: Ann Surg. 2009 Jul;250(1):141-51
references.pmid: 19561458
references.citation: World J Surg. 2008 Aug;32(8):1757-62
references.pmid: 18340479
references.citation: Eur J Surg Oncol. 2004 Apr;30(3):292-5
references.pmid: 15028311
references.citation: Transl Oncol. 2014 Apr;7(2):248-55
references.pmid: 24704092
references.citation: Ann Surg Oncol. 2012 Jan;19(1):217-24
references.pmid: 21638095
references.citation: Cancer. 2012 Mar 15;118(6):1726-37
references.pmid: 21953630
references.citation: Cancer Immunol Immunother. 2009 Jan;58(1):15-23
references.pmid: 18414853
references.citation: J Surg Oncol. 2010 Dec 1;102(7):742-7
references.pmid: 20872813
references.citation: Eur J Cancer. 2012 Jan;48(2):202-8
references.pmid: 22018713
references.citation: Eur Urol. 2006 Mar;49(3):466-5; discussion 475-7
references.pmid: 16442208
references.citation: Eur Urol. 2014 Jan;65(1):218-26
references.pmid: 22633802
references.citation: J Clin Oncol. 2006 May 1;24(13):1997-2005
references.pmid: 16648500
references.citation: J Surg Oncol. 2005 Sep 1;91(3):181-4
references.pmid: 16118772
references.citation: Oncology. 2007;73(3-4):215-20
references.pmid: 18424885
references.citation: Urol Oncol. 2013 Oct;31(7):1343-9
references.pmid: 22153754
references.citation: Urologia. 2014 Apr-Jun;81(2):120-4
references.pmid: 24474540
references.citation: Ann Surg Oncol. 2009 Mar;16(3):614-22
references.pmid: 19130139
references.citation: Urol Int. 2012;89(4):468-72
references.pmid: 23128367
references.citation: J Hepatol. 2013 Jan;58(1):58-64
references.pmid: 22925812
references.citation: Urol Oncol. 2015 Feb;33(2):67.e1-7
references.pmid: 25060672
references.citation: Tumour Biol. 2014 Jul;35(7):6601-5
references.pmid: 24696263
references.citation: J Natl Cancer Inst. 2014 May 29;106(6):dju124
references.pmid: 24875653
references.citation: World J Surg. 2014 Oct;38(10):2605-12
references.pmid: 24809487
references.citation: J Urol. 2010 Sep;184(3):873-8
references.pmid: 20643463
references.citation: J Urol. 2012 Feb;187(2):411-7
references.pmid: 22177153
references.citation: Nature. 2008 Jul 24;454(7203):436-44
references.pmid: 18650914
references.citation: Eur Urol. 2008 Aug;54(2):303-14
references.pmid: 18468779
references.citation: Colorectal Dis. 2013 Mar;15(3):323-8
references.pmid: 22958479
references.citation: Urology. 2005 Dec;66(6 Suppl 1):4-34
references.pmid: 16399414