Prognostic Role of Neutrophil-to-lymphocyte Ratio-based Markers During Pre- and Postadjuvant Chemotherapy in Patients With Advanced Urothelial Carcinoma of Upper Urinary Tract.
The aim of the present study was to assess the prognostic significance of neutrophil-to-lymphocyte ratio (NLR)-based markers before and after adjuvant chemotherapy (ACH) in patients with urothelial carcinoma of the upper urinary tract (UTUC) undergoing radical nephroureterectomy (RNU) and ACH.



The data from 112 patients with advanced UTUC who had undergone first-line ACH after RNU from 1994 to 2012 were reviewed. After excluding 22 patients, the clinicopathologic data for 90 patients were analyzed, in particular, the NLR and derived NLR (dNLR) preoperatively and before and after ACH. Cancer-specific survival (CSS) and overall survival (OS) outcomes were measured using Kaplan-Meier analysis. To identify the predictors for the oncologic outcomes, a multivariate Cox regression model was used.



Patients with a higher preoperative NLR, pre-ACH dNLR, and post-ACH dNLR had poorer CSS and OS than their counterparts with lower values. After adjustment of various clinicopathologic factors, age at surgery (≥ 65 years; hazard ratio [HR], 3.13) and higher post-ACH dNLR (HR, 3.06) remained significant predictors for CSS. Similarly, age (≥ 65 years; HR, 2.90) and elevated post-ACH dNLR (≥ 2.3; HR, 2.89) were also identified as predictors of OS on multivariate analysis.



A higher post-ACH dNLR was independently predictive of poor CSS and OS in patients with advanced UTUC receiving systemic ACH after RNU. From the obtained data, we propose that the NLR-based marker could be a readily available and valuable biomarker for predicting oncologic outcomes after chemotherapy.
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Minyong
M
Kang
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Chang Wook
CW
Jeong
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Cheol
C
Kwak
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea.
Hyeon Hoe
HH
Kim
Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kuuro70@snu.ac.kr.
Ja Hyeon
JH
Ku
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D000074682:Nephroureterectomy; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology / Q000601:surgery
Adjuvant chemotherapy; Neutrophil-lymphocyte ratio; Predictive factors; Upper urinary tract; Urothelial carcinoma