title: Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of survival in patients with metastatic urothelial carcinoma: A multi-institutional study.
abstract: OBJECTIVE
  To evaluate the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio in patients with metastatic urothelial carcinoma who underwent salvage chemotherapy.
  
  
  METHODS
  We reviewed 200 metastatic urothelial carcinoma patients who received salvage chemotherapy at our five affiliate institutions between 2003 and 2011. The associations of pretreatment clinicopathological factors, including neutrophil-to-lymphocyte ratio, with cancer-specific survival and overall survival from the start of chemotherapy were assessed. Cox proportional hazards model was used for multivariate analysis.
  
  
  RESULTS
  A total of 15 cases with missing data were excluded. Among the remaining 185 patients, 157 died during follow up, with a median survival of 13.0 months. Multivariate analysis showed that the pretreatment neutrophil-to-lymphocyte ratio ≥3, Eastern Cooperative Oncology Group performance status ≥2 and liver metastasis were independent poor prognostic factors, both for cancer-specific survival and overall survival. A prognostic model predicting overall survival was constructed based on the number of these three variables (0, 1 and ≥ 2). The classified patients showed significantly different overall survival (each P < 0.0001, log-rank test), with Harrell's concordance index as high as 0.81.
  
  
  CONCLUSIONS
  Pretreatment neutrophil-to-lymphocyte ratio elevation was an independent poor prognostic factor for metastatic urothelial carcinoma undergoing salvage chemotherapy. Our newly constructed prognostic model including the pretreatment neutrophil-to-lymphocyte ratio proved to be an excellent discriminator of overall survival.
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Taguchi
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagase
authors.affiliation: Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Taketo
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Sachi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Enomoto
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Yorito
authors.initials: Y
authors.lastname: Nose
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
authors.affiliation: Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.affiliation: Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009504:Neutrophils / Q000166:cytology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D014571:Urologic Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: bladder cancer; chemotherapy; metastatic; neutrophil-to-lymphocyte ratio; urothelial carcinoma