The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.
BACKGROUND
The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with recurrence and poor prognosis in numerous cancer types. The aim of this study was to evaluate the use of the NLR as a biomarker for intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) for the first time.


METHODS
We retrospectively analyzed the records of 100 patients with UTUC who had undergone RNU between 1999 and 2015 at our institution. The association between the preoperative NLR and IVR were assessed using multivariate models.


RESULTS
Among the 100 patients enrolled in the study, 33 developed IVR during a median follow-up of 34 months. The receiver operating characteristic analysis revealed that the optimum cut-off value for the preoperative NLR was >3.8. A high preoperative NLR (n = 21) was associated with a significantly increased risk of lymph node involvement (p = 0.036) and IVR (p = 0.034) compared with a low preoperative NLR (n = 79). IVR-free survival in patients with a high preoperative NLR was significantly worse than that of patients with a low preoperative NLR (p = 0.018). On multivariate analysis, the preoperative NLR [hazard ratio (HR) 2.49; p = 0.015] and tumor multifocality (HR 2.96; p = 0.024) were independent risk factors predictive of IVR.


CONCLUSIONS
In our study population of patients with UTUC who had undergone RNU the preoperative NLR was associated with a significantly increased risk of IVR, suggesting that the NRL could be a useful biomarker for predicting IVR.
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Nozomu
N
Kishimoto
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan. takao@gh.opho.jp.
Tetsuya
T
Takao
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Sohei
S
Kuribayashi
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Gaku
G
Yamamichi
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Kosuke
K
Nakano
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Masataka
M
Kawamura
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Koichi
K
Tsutahara
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Go
G
Tanigawa
Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Seiji
S
Yamaguchi
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009392:Nephrectomy; D009504:Neutrophils; D057234:Preoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000556:secondary
Intravesical recurrence; Nephroureterectomy; Neutrophil-to-lymphocyte ratio; Upper urinary tract urothelial carcinoma