title: Low Pretreatment Neutrophil-to-Lymphocyte Ratio Predicts for Good Outcomes in Patients Receiving Neoadjuvant Chemotherapy Before Radical Cystectomy for Muscle Invasive Bladder Cancer.
abstract: The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been associated with cancer prognosis, influencing progression and chemosensitivity. We aimed to define the role of the NLR in predicting the outcomes to neoadjuvant chemotherapy (NAC) in patients with muscle invasive bladder cancer (MIBC).
  
  
  
  The data from patients treated with NAC and radical cystectomy for MIBC from 2007 to 2015 at a tertiary care center were reviewed. The clinicopathologic pretreatment, including the NLR, and post-treatment predictors were documented. The NLR was evaluated as a continuous variable on uni- and multivariate analysis and dichotomized in Kaplan-Meier curves. The relationships with outcomes (progression-free survival [PFS], cancer-specific survival [CSS], and overall survival [OS]) were analyzed using Cox regression analysis and log-rank tests. The pathologic response (PR) included any downstaging from the baseline clinical stage to the final pathologic stage.
  
  
  
  Of 205 patients with MIBC, 75 underwent NAC (median follow-up, 31 months) with a 5-year PFS, CSS, and OS rate of 56%, 60%, and 52%, respectively, and a PR of 38.6%. On multivariate analysis, the PR, PFS, CSS, and OS were predicted by the NLR (hazard ratio > 0.8, 1.25, 1.27, and 1.12, respectively; P < .05 for all). The NLR with age and clinical stage predicted the PR. A NLR threshold of 2.26 better predicted CSS (P < .05) and OS (P = .055). The limitations included the retrospective design and modest number of cases.
  
  
  
  We have provided initial evidence that a low NLR helps understand the value of the underlying immune system in predicting a good outcome to NAC. The NLR is a simple and accessible biomarker that is easy to implement in clinical practice. In addition to established prognosticators and newer genomic predictors, the NLR could improve therapeutic algorithms and help in decision-making regarding the need for NAC, which is currently underused, in MIBC patients.
authors.affiliation: Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Buisan
authors.affiliation: Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA. Electronic address: annaorsola@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Orsola
authors.affiliation: Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Areal
authors.affiliation: Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Font
authors.affiliation: Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
authors.affiliation: Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ibarz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009504:Neutrophils / Q000166:cytology*; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents
keywords: MIBC; NLR; Neoadjuvant therapy; RC; Urothelial cancer