title: The Clinical Use of the Neutrophil to Lymphocyte Ratio (NLR) in Urothelial Cancer: A Systematic Review.
abstract: The neutrophil to lymphocyte ratio (NLR) is an inflammatory index that has been considered as a potential prognostic factor in human cancer. The aim of this study was to evaluate the available evidence regarding the NLR as a prognostic value in patients affected by urothelial cancer. This literature review, including papers on NLR in urothelial cancers, was done on PubMed/Medline and Cochrane libraries in November 2015. The selection of the articles followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Twenty-three of 99 articles fulfilled all the inclusion criteria, including data on 6240 patients affected by urothelial cancers. Overall, cancer-specific, and recurrence-free survival were evaluated as the main oncological outcomes. There was significant heterogeneity among studies, and the majority of studies were of poor quality. Overall, NLR was considered as a prognostic marker in 87.5%, 80%, and 60% of the studies on upper tract urothelial cancer, urothelial bladder cancer, and metastatic and advanced disease, respectively. The NLR cut-off value ranged between 2 and 5. A high NLR was associated with worse overall, cancer-specific, and recurrence-free survival. NLR is a widely available, easy-to-collect, costless, prognostic marker in urothelial cancers. Its clinical use still remains under investigation, especially for the need for cut-off values, particularly in different subsets of patients.
authors.affiliation: Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. Electronic address: mic.marchioni@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Marchioni
authors.affiliation: Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Primiceri
authors.affiliation: Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Ingrosso
authors.affiliation: Division of Molecular Metabolism, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Roberta
authors.initials: R
authors.lastname: Filograna
authors.affiliation: Department of Urology, Robotic Unit, ASL Abruzzo 2, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellan
authors.affiliation: Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Piergustavo
authors.initials: P
authors.lastname: De Francesco
authors.affiliation: Department of Urology, Robotic Unit, ASL Abruzzo 2, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000473:pathology*; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D011379:Prognosis; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000473:pathology*
keywords: Bladder cancer; Neutrophil to lymphocyte ratio; Oncologic outcome; Prognostic value; Upper tract urothelial cancer