title: A novel risk stratification model, involving preoperative lymphocyte-monocyte ratio and standard pathological factors, for overall survival in patients with bladder cancer undergoing radical cystectomy.
abstract: OBJECTIVE
  To evaluate the ability of preoperative lymphocyte-monocyte ratio to predict prognosis and determine post-operative risk stratification in patients with bladder cancer undergoing radical cystectomy.
  
  
  METHODS
  A retrospective review of the 210 patients who had undergone radical cystectomy for bladder cancer from 2006 to 2013 identified 181 patients with sufficient data to evaluate the prognostic significance of the lymphocyte-monocyte ratio. Overall survival was assessed by the Kaplan-Meier method. The association of clinicopathological findings with overall survival was evaluated by a multivariate Cox proportional model, and a novel risk stratification model to predict prognosis was established.
  
  
  RESULTS
  Median follow-up after radical cystectomy was 6.0 years. The 5-year overall survival rate was significantly lower for patients with low than high lymphocyte-monocyte ratio (27.6 vs 80.7%, P < 0.001). Multivariable analyses showed that pT ≥2, pN ≥1, positive margins and low lymphocyte-monocyte ratio were independent predictors of overall survival. A post-operative risk stratification model using these factors showed significant differences among the three subgroups (low, intermediate and high risk) with a concordance index of 0.84. The 5-year overall survival rates in patients at low, intermediate and high risk were 85.4, 45.5 and 0%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Preoperative lymphocyte-monocyte ratio, pathological tumor and lymph node stage and positive margins are significantly associated with overall survival in patients who have undergone radical cystectomy for bladder cancer.
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka kinoshih@hirakata.kmu.ac.jp.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yanishi
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Inui
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komai
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Sugi
authors.affiliation: Department of Urology and Andrology, Takii Hospital, Kansai Medical University, Osaka, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology and Andrology, Takii Hospital, Kansai Medical University, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murota
authors.affiliation: Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009000:Monocytes / Q000473:pathology*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*
keywords: bladder cancer; lymphocyte–monocyte ratio; radical cystectomy; risk stratification model