title: Prognostic Value of Baseline Neutrophil-to-Lymphocyte Ratio in Metastatic Urothelial Carcinoma Patients Treated With First-line Chemotherapy: A Large Multicenter Study.
abstract: A high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and is associated with poor survival in localized or metastatic cancer. This study assessed the prognostic value of NLR after first-line chemotherapy (CT) in patients with metastatic urothelial carcinoma (mUC).
  
  
  
  Two hundred eighty consecutive patients treated with first-line platinum-based CT at 4 centers in France and Turkey between 2002 and 2014 were included. The association of NLR and Memorial Sloan Kettering Cancer Center (MSKCC) scores with overall survival (OS) and progression-free survival (PFS) was determined by univariate Cox models.
  
  
  
  Median OS was 10.6 months (follow-up, 42.8 months). In univariate analysis, high NLR was associated with worse OS (hazard ratio [HR] for death = 1.36; 95% confidence interval [CI], 1.23-1.51; P < .0001); the result was similar after adjustment for MSKCC prognostic group (HR = 1.28; 95% CI, 1.14-1.43; P < .0001). Low NLR was associated with longer PFS (HR = 1.18; 95% CI, 1.05-1.33; P < .005). When NLR was divided in terciles, OS in the lowest tercile (NLR 0.6-2.78) was 12.4 to 16.6 (median, 13.4) months versus 5.3 to 9.9 (median, 7.3) months in the highest tercile (NLR 4.70-48.9) (P = .001). Similar trends were observed for PFS (5.6-8.9 [median, 7.6] months vs. 3.1-5.7 [median, 4.8] months) in patients with NLR values in the lowest versus highest tercile, respectively (P = .021).
  
  
  
  High pre-CT NLR was an independent prognostic factor for poor OS and PFS in mUC patients. The prognostic value of NLR, as either a continuous or categorical variable, compared favorably with MSKCC score but was easier to assess and monitor.
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France. Electronic address: marie.auvray2@aphp.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Auvray
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Elaidi
authors.affiliation: Oncology Department, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozguroglu
authors.affiliation: Oncology Department, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Sermin
authors.initials: S
authors.lastname: Guven
authors.affiliation: Oncology Department, Saint-Louis Hospital, Diderot University, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Gauthier
authors.affiliation: Oncology Department, Saint-Louis Hospital, Diderot University, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
authors.affiliation: Oncology Department, Ramsay Générale de Santé, La Louvière Private Hospital, Lille, France.
authors.forename: Armelle
authors.initials: A
authors.lastname: Caty
authors.affiliation: Oncology Department, Ramsay Générale de Santé, La Louvière Private Hospital, Lille, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Dujardin
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Auclin
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Thibaut
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Combe
authors.affiliation: INSERM U970 PARCC, René Descartes University, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Tartour
authors.affiliation: Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oudard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D014408:Biomarkers, Tumor / Q000097:blood*; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014421:Turkey; D014571:Urologic Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*
chemical_list: D014408:Biomarkers, Tumor
keywords: Biomarker; Inflammation; Overall survival; Prognostic value; Progression-free survival