title: Neutrophil to lymphocyte ratio, a biomarker in non-muscle invasive bladder cancer: a single-institutional longitudinal study.
abstract: BACKGROUND
  Bladder cancer represents one of the most important clinical challenges in urologic practice. In this context, inflammation has an important role in the development and progression of many malignancies. The objective of the present study was to evaluate the prognostic value of pre-treatment Neutrophil to lymphocyte ratio (NLR) on the risk of recurrence and progression in patients with primary non-muscle invasive bladder cancer.
  
  
  METHODS
  Data obtained from 178 bladder cancer patients who underwent transurethral resection of bladder tumor (TURB) between July 2008 and December 2014 were evaluated prospectively. NLR was obtained from each patient before TURB and defined as the absolute neutrophil count divided by the absolute lymphocyte count. Cox proportional hazards regression model was performed to calculate disease recurrence and progression including NLR.
  
  
  RESULTS
  During the follow-up study (median: 53 months), 14 (23.3%) and 44 (37.9%) (p=0.04) patients respectively with NLR<3 and ≥3experienced recurrence and 2 (3.3%) and 14 (11.9%) experienced progression (p=0.06), respectively. At the multivariate Cox regression analysis, NLR ≥3 was associated with worse disease recurrence (HR: 2.84; p<0.01). No association was found regarding disease progression. The 5-year recurrence free survival was 49% and 62% in patients with NLR≥3 and <3 (p<0.01). The 5-year progression free survival was 77% and 93% in patients with NLR≥3 and <3 (p=0.69).
  
  
  CONCLUSIONS
  NLR predicts disease recurrence but not disease progression in NMIBC patients. NLR alterations may depend of tumor inflammatory microenvironment.
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Vincenzo
authors: V
authors: Favilla
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Tommaso
authors: T
authors: Castelli
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Daniele
authors: D
authors: Urzì
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Giulio
authors: G
authors: Reale
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Salvatore
authors: S
authors: Privitera
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Antonio
authors: A
authors: Salici
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Giorgio Ivan
authors: GI
authors: Russo
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Sebastiano
authors: S
authors: Cimino
authors: Sezione Urologia, Dipartimento di Chirurgia, Università di Catania, Italia.
authors: Giuseppe
authors: G
authors: Morgia
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001772:Blood Cell Count; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D009361:Neoplasm Invasiveness; D009504:Neutrophils; D011379:Prognosis; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor
keywords: Biomarkers; Neutrophils; Urinary Bladder Neoplasms