Buisan Oscar, Orsola Anna, Areal Joan, Font Albert, Oliveira Mario, Martinez Roberto, Ibarz Luis
Department of Urology, Hospital Universitari Germans Trias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA.
Clin Genitourin Cancer. 2017 Feb;15(1):145-151.e2. doi: 10.1016/j.clgc.2016.05.004. Epub 2016 Jun 1.
The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been associated with cancer prognosis, influencing progression and chemosensitivity. We aimed to define the role of the NLR in predicting the outcomes to neoadjuvant chemotherapy (NAC) in patients with muscle invasive bladder cancer (MIBC).
The data from patients treated with NAC and radical cystectomy for MIBC from 2007 to 2015 at a tertiary care center were reviewed. The clinicopathologic pretreatment, including the NLR, and post-treatment predictors were documented. The NLR was evaluated as a continuous variable on uni- and multivariate analysis and dichotomized in Kaplan-Meier curves. The relationships with outcomes (progression-free survival [PFS], cancer-specific survival [CSS], and overall survival [OS]) were analyzed using Cox regression analysis and log-rank tests. The pathologic response (PR) included any downstaging from the baseline clinical stage to the final pathologic stage.
Of 205 patients with MIBC, 75 underwent NAC (median follow-up, 31 months) with a 5-year PFS, CSS, and OS rate of 56%, 60%, and 52%, respectively, and a PR of 38.6%. On multivariate analysis, the PR, PFS, CSS, and OS were predicted by the NLR (hazard ratio > 0.8, 1.25, 1.27, and 1.12, respectively; P < .05 for all). The NLR with age and clinical stage predicted the PR. A NLR threshold of 2.26 better predicted CSS (P < .05) and OS (P = .055). The limitations included the retrospective design and modest number of cases.
We have provided initial evidence that a low NLR helps understand the value of the underlying immune system in predicting a good outcome to NAC. The NLR is a simple and accessible biomarker that is easy to implement in clinical practice. In addition to established prognosticators and newer genomic predictors, the NLR could improve therapeutic algorithms and help in decision-making regarding the need for NAC, which is currently underused, in MIBC patients.
治疗前中性粒细胞与淋巴细胞比值（NLR）与癌症预后相关，影响疾病进展和化疗敏感性。我们旨在明确NLR在预测肌层浸润性膀胱癌（MIBC）患者新辅助化疗（NAC）疗效中的作用。
回顾了2007年至2015年在一家三级医疗中心接受NAC及根治性膀胱切除术治疗的MIBC患者的数据。记录了包括NLR在内的临床病理治疗前指标及治疗后预测指标。在单因素和多因素分析中，将NLR作为连续变量进行评估，并在Kaplan-Meier曲线中进行二分法分析。使用Cox回归分析和对数秩检验分析其与预后（无进展生存期[PFS]、癌症特异性生存期[CSS]和总生存期[OS]）的关系。病理反应（PR）包括从基线临床分期到最终病理分期的任何降期。
205例MIBC患者中，75例接受了NAC（中位随访时间31个月），5年PFS、CSS和OS率分别为56%、60%和52%，PR为38.6%。多因素分析显示，PR、PFS、CSS和OS可通过NLR预测（风险比分别>0.8、1.25、1.27和1.12；均P<0.05）。NLR联合年龄和临床分期可预测PR。NLR阈值为2.26时对CSS（P<0.05）和OS（P=0.055）的预测效果更佳。局限性包括回顾性设计和病例数量有限。
我们提供了初步证据，表明低NLR有助于理解潜在免疫系统在预测NAC良好疗效中的价值。NLR是一种简单且易于获取的生物标志物，便于在临床实践中应用。除了既定的预后指标和更新的基因组预测指标外，NLR可改进治疗算法，并有助于就目前使用不足的MIBC患者是否需要进行NAC做出决策。
