title: Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio as biomarkers for predicting lymph node metastasis and survival in patients treated with radical cystectomy.
abstract: OBJECTIVE
  To evaluate the role of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) as pre-operative markers for predicting extravesical disease and survival outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).
  
  
  METHODS
  Data from 4335 patients undergoing RC for clinically non-metastatic UCB were analyzed. Multivariable logistic regression models were used to predict lymph node involvement and extravesical disease (defined as ≥pT3 and N0). Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were evaluated using multivariable Cox models. The accuracy of the models was assessed with receiver operating characteristics (ROC) curves and concordance-index.
  
  
  RESULTS
  Median LMR was 3.5 and median NLR was 2.7. Addition of LMR and NLR to a standard preoperative model improved its discrimination for prediction of lymph node metastasis by 4.5%. On multivariable analysis LMR and NLR independently predicted RFS, CSS, and OS. The discrimination of this model increased by adding LMR and NLR but was not significant.
  
  
  CONCLUSIONS
  LMR and NLR independently improved the preoperative prediction of lymph node metastasis and survival outcomes. As they are readily available, they could be integrated in a panel of preoperative markers helping selecting patients who have extravesical lymph node involvement and more aggressive disease.
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: David
authors.initials: D
authors.lastname: D'Andrea
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.|Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner University, Krems an der Donau, Austria.
authors.forename: Kilian M
authors.initials: KM
authors.lastname: Gust
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abufaraj
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Özsoy
authors.affiliation: Department of Urology, Rennes University Hospital, Rennes, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Department of Urology, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Soria
authors.affiliation: Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, Pitié-Salpétrière Hospital, APHP, University Paris VI, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner University, Krems an der Donau, Austria.|Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism; D015999:Multivariate Analysis; D009504:Neutrophils / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery
chemical_list: D015415:Biomarkers
keywords: bladder; carcinoma; cystectomy; lymphocyte-to-monocyte ratio; neutrophil-to-lymphocyte ratio; transitional cell