title: Role of Inflammation in the Perioperative Management of Urothelial Bladder Cancer With Squamous-Cell Features: Impact of Neutrophil-to-Lymphocyte Ratio on Outcomes and Response to Neoadjuvant Chemotherapy.
abstract: Neutrophil-to-lymphocyte ratio (NLR) might reflect an increased neutrophilic inflammatory response, and urothelial tumors with squamous-cell features (SqD) have been linked to inflammation. We hypothesized that NLR could be prognostic in these patients.
  
  
  
  In patients with SqD muscle-invasive bladder cancer treated with curative intent, NLR and relationships with outcomes were analyzed by Cox regression, log-rank, and Kaplan-Meier analysis.
  
  
  
  Fifty patients presented SqD (median follow-up, 29 months). The ideal NLR cutoff (by receiver operating characteristic curves) was 5. Thirty-seven patients had NLR < 5 and 13 had NLR ≥ 5. The 5-year progression-free survival, cancer-specific survival (CSS), and overall survival were 46.8%, 48.4%, and 45% for NLR < 5 cases, and 10.3%, 10.3%, and 11.7% for NLR ≥ 5 cases (all P < .05). On multivariate analysis, NLR was prognostic (hazard ratio = 4.26, 6.21, and 4.08 for progression-free survival, CSS, and overall survival). Neoadjuvant chemotherapy (NAC) was of significant benefit in NLR < 5 patients, with a CSS of 91.2 months (n = 3) versus 38.1 months (n = 24) for those treated with up-front radical cystectomy (P = .009); Kaplan-Meier curves were also significantly different. These differences did not reach statistical significance for patients with NLR ≥ 5. For the 19 patients treated with NAC, NLR was also predictive of response to NAC.
  
  
  
  Inflammation, measured by NLR, is potentially prognostic in the perioperative management of SqD. NLR identifies 2 risk groups. Patients displaying low NLR had a 4-fold survival improvement and were highly responsive to NAC. NLR might be a good prognostic tool. Its role as a predictor of response to NAC deserves future study, along with its role as a selection criterion for therapies other than chemotherapy.
authors.affiliation: Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Buisan
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA. Electronic address: annaorsola@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Orsola
authors.affiliation: Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
authors.affiliation: Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Olatz
authors.initials: O
authors.lastname: Etxaniz
authors.affiliation: Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Areal
authors.affiliation: Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ibarz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000276:immunology*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000276:immunology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009504:Neutrophils; D059035:Perioperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000276:immunology*
keywords: Mixed tumors; Muscle invasive; Neoadjuvant therapy; Predictors; Radical cystectomy; Survival urothelial carcinoma; Variant histology