Tan Yu Guang, Eu Ernest Wen Cong, Huang Hong Hong, Lau Weber Kam On
Department of Urology, Singapore General Hospital, Singapore.
Int J Urol. 2018 Mar;25(3):232-238. doi: 10.1111/iju.13480. Epub 2017 Nov 1.
To study the role of the neutrophil-to-lymphocyte ratio in predicting survival outcomes for patients with advanced bladder cancer.
We retrospectively reviewed 150 patients diagnosed with advanced or metastatic bladder cancer between January 2004 and June 2014. The neutrophil-to-lymphocyte ratio was computed on diagnosis and after the first cycle of chemotherapy. A neutrophil-to-lymphocyte ratio cut-off of 3.0 was determined, with a concordance index of 0.89. Kaplan-Meier curves, log-rank tests, Cox proportional hazards and logistic regression models were used to predict the association of the neutrophil-to-lymphocyte ratio with survival outcomes.
Just five patients were alive at the end of the study; the rest died from metastatic bladder cancer. On multivariate analysis, higher Eastern Cooperative Oncology Group status, lymphadenopathy, visceral metastases and neutrophil-to-lymphocyte ratio ≥3.0 were associated with poorer overall survival (hazard ratio 1.67, P = 0.03; hazard ratio 1.97, P = <0.01; hazard ratio 2.02, P = <0.01; hazard ratio 5.06, P = <0.01), whereas chemotherapy conferred better overall survival (hazard ratio 0.546, P = 0.01). Furthermore, the role of chemotherapy prolonged survival longer in patients with a neutrophil-to-lymphocyte ratio <3.0 (median overall survival 13.0 vs 22.0 months, hazard ratio 0.273, P = 0.008) compared with a neutrophil-to-lymphocyte ratio ≥3.0 (median overall survival 4.0 vs 7.0 months, hazard ratio 0.452, P = 0.020). More importantly, when dichotomized to the four different pre- and post-chemotherapy groups, patients with a pre- and post-chemotherapy neutrophil-to-lymphocyte ratio <3.0 had the best additional median overall survival of 19.0 months compared with patients with a pre- and post-chemotherapy neutrophil-to-lymphocyte ratio ≥3.0 (3.0 months).
Elevated neutrophil-to-lymphocyte ratio is independently associated with poorer chemotherapeutic response and overall survival in patients with advanced or metastatic bladder cancer. The neutrophil-to-lymphocyte ratio can be an inexpensive novel factor in prognosticating disease progression and providing better patient counseling.
研究中性粒细胞与淋巴细胞比值在预测晚期膀胱癌患者生存结局中的作用。
我们回顾性分析了2004年1月至2014年6月期间确诊为晚期或转移性膀胱癌的150例患者。在诊断时及化疗第一个周期后计算中性粒细胞与淋巴细胞比值。确定中性粒细胞与淋巴细胞比值的临界值为3.0，一致性指数为0.89。采用Kaplan-Meier曲线、对数秩检验、Cox比例风险模型和逻辑回归模型来预测中性粒细胞与淋巴细胞比值与生存结局的关联。
研究结束时仅有5例患者存活；其余患者死于转移性膀胱癌。多因素分析显示，东部肿瘤协作组状态较高、存在淋巴结病、内脏转移以及中性粒细胞与淋巴细胞比值≥3.0与较差的总生存期相关（风险比1.67，P = 0.03；风险比1.97，P = <0.01；风险比2.02，P = <0.01；风险比5.06，P = <0.01），而化疗可带来更好的总生存期（风险比0.546，P = 0.01）。此外，与中性粒细胞与淋巴细胞比值≥3.0（中位总生存期4.0个月对7.0个月，风险比0.452，P = 0.020）相比，化疗在中性粒细胞与淋巴细胞比值<3.0的患者中延长生存期的作用更显著（中位总生存期13.0个月对22.0个月，风险比0.273，P = 0.008）。更重要的是，当分为化疗前和化疗后四个不同组时，化疗前和化疗后中性粒细胞与淋巴细胞比值<3.0的患者的额外中位总生存期最长，为19.0个月，而化疗前和化疗后中性粒细胞与淋巴细胞比值≥3.0的患者为3.0个月。
中性粒细胞与淋巴细胞比值升高与晚期或转移性膀胱癌患者化疗反应较差及总生存期较差独立相关。中性粒细胞与淋巴细胞比值可成为预测疾病进展及为患者提供更好咨询的廉价新指标。
