title: Perioperative change in neutrophil-lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy.
abstract: OBJECTIVE
  To assess the prognostic value of perioperative changes in the neutrophil-lymphocyte ratio in patients with bladder cancer undergoing radical cystectomy.
  
  
  METHODS
  We performed a retrospective analysis of 323 patients who had undergone radical cystectomy at our institutions. Overall survival was assessed with the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  Preoperative and postoperative neutrophil-lymphocyte ratios were significantly correlated with overall survival (both P = 0.0001). Changes in perioperative neutrophil-lymphocyte ratio stratified the patients into two groups, designated favorable- and poor-risk groups, with significantly different 5-year overall survival rates (75.1% and 41.4%, respectively; P < 0.0001). Multivariate Cox regression analyses showed that the perioperative change in neutrophil-lymphocyte ratio was an independent prognostic factor for overall survival (hazard ratio 2.56, 95% confidence interval 1.75-3.73; P < 0.001). Moreover, a decrease in neutrophil-lymphocyte ratio after adjuvant chemotherapy was associated with favorable overall survival in patients with high postoperative neutrophil-lymphocyte ratio (P < 0.001), indicating that neutrophil-lymphocyte ratio may be a predictive factor for the efficacy of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Perioperative changes in neutrophil-lymphocyte ratio are significantly associated with overall survival in patients with bladder cancer undergoing radical cystectomy. Follow-up of the neutrophil-lymphocyte ratio change may be useful for the clinical management of patients after surgery.
authors: Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka.
authors: Takashi
authors: T
authors: Yoshida
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka kinoshih@hirakata.kmu.ac.jp.
authors: Hidefumi
authors: H
authors: Kinoshita
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Kenji
authors: K
authors: Yoshida
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Takao
authors: T
authors: Mishima
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Masaaki
authors: M
authors: Yanishi
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Yoshihiro
authors: Y
authors: Komai
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Motohiko
authors: M
authors: Sugi
authors: Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka.
authors: Takashi
authors: T
authors: Murota
authors: Department of Urology, Saiseikai Noe Hospital, Osaka, Japan.
authors: Gen
authors: G
authors: Kawa
authors: Department of Urology and Andrology, Kansai Medical University Hospital, Osaka.
authors: Tadashi
authors: T
authors: Matsuda
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents
keywords: bladder cancer; neutrophil–lymphocyte ratio; perioperative change; radical cystectomy