Buisan Oscar, Orsola Anna, Oliveira Mario, Martinez Roberto, Etxaniz Olatz, Areal Joan, Ibarz Luis
Department of Urology, Hospital Universitari GermansTrias i Pujol and Autonomous University of Barcelona, Barcelona, Spain.
Dana-Farber Cancer Institute, Boston, MA.
Clin Genitourin Cancer. 2017 Aug;15(4):e697-e706. doi: 10.1016/j.clgc.2017.01.024. Epub 2017 Feb 6.
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.
中性粒细胞与淋巴细胞比值（NLR）可能反映中性粒细胞炎症反应增强，且具有鳞状细胞特征的尿路上皮肿瘤（SqD）与炎症有关。我们推测NLR对这些患者具有预后价值。
对接受根治性治疗的SqD肌层浸润性膀胱癌患者，采用Cox回归、对数秩检验和Kaplan-Meier分析来分析NLR及其与预后的关系。
50例患者表现为SqD（中位随访时间为29个月）。通过受试者工作特征曲线得出理想的NLR临界值为5。37例患者NLR < 5，13例患者NLR≥5。NLR < 5组的5年无进展生存率、癌症特异性生存率（CSS）和总生存率分别为46.8%、48.4%和45%，NLR≥5组分别为10.3%、10.3%和11.7%（所有P < .05）。多因素分析显示，NLR具有预后价值（无进展生存率、CSS和总生存率的风险比分别为4.26、6.21和4.08）。新辅助化疗（NAC）对NLR < 5的患者有显著益处，接受NAC治疗患者的CSS为91.2个月（n = 3），而接受 upfront根治性膀胱切除术患者的CSS为38.1个月（n = 二十四）（P = .009）；Kaplan-Meier曲线也有显著差异。对于NLR≥5的患者，这些差异未达到统计学意义。对于接受NAC治疗的19例患者，NLR也可预测对NAC的反应。
通过NLR衡量的炎症在SqD围手术期管理中可能具有预后价值。NLR可识别两个风险组。NLR低的患者生存率提高4倍，且对NAC反应良好。NLR可能是一个良好的预后工具。其作为NAC反应预测指标的作用以及作为化疗以外其他治疗选择标准的作用值得未来研究。
