title: Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy.
abstract: BACKGROUND
  We sought to determine which parsimonious combination of complete blood count (CBC)-based biomarkers most efficiently predicts oncologic outcomes in patients undergoing radical cystectomy (RC) for bladder cancer (BC).
  
  
  METHODS
  Using our institutional RC database (1992-2012), nine CBC-based markers (including both absolute cell counts and ratios) were evaluated based on pre-treatment measurements. The outcome measures were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Time-dependent receiver-operating characteristics curves were used to characterise each biomarker. The CBC-based biomarkers, along with several clinical predictors, were then considered for inclusion in predictive multivariable Cox models based on the Akaike Information Criterion.
  
  
  RESULTS
  Our cohort included 418 patients. Neutrophil-lymphocyte ratio (NLR) was the only biomarker satisfying criteria for inclusion into all models, independently predicting RFS (HR per 1-log unit=1.52, 95% CI=1.17-1.98, P=0.002), CSS (HR=1.47, 95% CI=1.20-1.80, P<0.001), and OS (HR=1.56, 95% CI=1.16-2.10, P=0.004). Haemoglobin was also independently predictive of CSS (HR per 1 g/dl=0.91, 95% CI=0.86-0.95, P<0.001) and OS (HR=0.90, 95% CI=0.88-0.93, P<0.001), but not RFS.
  
  
  CONCLUSIONS
  Among CBC biomarkers studied, NLR was the most efficient marker for predicting RFS, whereas NLR and haemoglobin were most efficient in predicting CSS and OS. NLR and haemoglobin are promising, cost-effective, independent biomarkers for predicting oncologic BC outcomes following RC.
  
  
  CONCLUSIONS
  Various CBC-based biomarkers have separately been shown to be predictive of oncologic outcomes in patients undergoing cystectomy for BC. Our study evaluated these biomarkers, and determined that NLR is the best CBC-based biomarker for predicting RFS, whereas NLR and haemoglobin are most efficient for predicting CSS and OS.
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Bimal
authors.initials: B
authors.lastname: Bhindi
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.|Department of Urology, University of Zürich, Ramistrasse 71, Zürich 8006, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hermanns
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Yanliang
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Anesthesia, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Richard
authors.affiliation: Department of Urology, University of Zürich, Ramistrasse 71, Zürich 8006, Switzerland.
authors.forename: Marian S
authors.initials: MS
authors.lastname: Wettstein
authors.affiliation: Department of Medical Oncology, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.|Department of Medical Oncology, Kantonsspital St Gallen, Rorschacher Street 95, St Gallen, Switzerland.
authors.forename: Arnoud
authors.initials: A
authors.lastname: Templeton
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Michael A S
authors.initials: MA
authors.lastname: Jewett
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.|Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.|Institute for Clinical and Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Girish S
authors.initials: GS
authors.lastname: Kulkarni
mesh_terms: D000368:Aged; D015415:Biomarkers; D001772:Blood Cell Count; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000601:surgery*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins