Kaiser Jeenan, Li Haocheng, North Scott A, Leibowitz-Amit Raya, Seah Jo-An, Morshed Nisha, Chau Caroline, Lee-Ying Richard, Heng Daniel Y C, Sridhar Srikala, Crabb Simon J, Alimohamed Nimira S
Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Bladder Cancer. 2018 Apr 26;4(2):185-194. doi: 10.3233/BLC-170133.
The impact of the change in the neutrophil-to-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NAC) on outcomes in patients with muscle-invasive bladder cancer (MIBC) is poorly understood.
To evaluate the prognostic impact of the change in NLR during NAC for patients with MIBC.
Patients referred to academic, community, and quaternary referral centres in Alberta, Canada from 2005 to 2015, Ontario, Canada from 2005 to 2013, and Southampton, UK from 2004 to 2010 were evaluated. 376 eligible patients were treated with NAC for clinical T2-4aN0M0 disease, and 296 were evaluable for the change in NLR. A high NLR was defined as being an NLR > 3. Relationships between the change in NLR from baseline to mid-NAC (pre-cycle 3) and outcomes were analyzed using multivariable Cox regression. Kaplan-Meier analysis was used with the log-rank test for group comparisons.
Median follow-up was 22.0 months (95% confidence interval [CI]: 14.9-30.0). Patients with a sustained high NLR had a median disease-free survival (DFS) of 12.6 months, compared to 34.8 months for those with a sustained low NLR (log-rank test = 0.0025; hazard ratio [HR] 0.61 [95% CI: 0.44-0.84]). Median overall survival (OS) was 19.4 months for patients with a sustained high NLR, compared to 44.0 months for patients with a sustained low NLR (log-rank test = 0.0011; HR 0.54 [95% CI: 0.38-0.77]).
A sustained high NLR from baseline to mid-NAC is an independent prognostic factor for patients with MIBC.
新辅助化疗（NAC）期间中性粒细胞与淋巴细胞比值（NLR）的变化对肌层浸润性膀胱癌（MIBC）患者预后的影响尚不清楚。
评估NAC期间NLR变化对MIBC患者的预后影响。
对2005年至2015年转诊至加拿大艾伯塔省学术、社区和四级转诊中心、2005年至2013年加拿大安大略省以及2004年至2010年英国南安普敦的患者进行评估。376例符合条件的患者接受了NAC治疗临床T2-4aN0M0疾病，其中296例可评估NLR变化。高NLR定义为NLR>3。使用多变量Cox回归分析从基线到NAC中期（第3周期前）NLR的变化与预后之间的关系。采用Kaplan-Meier分析和对数秩检验进行组间比较。
中位随访时间为22.0个月（95%置信区间[CI]：14.9-30.0）。NLR持续高的患者中位无病生存期（DFS）为12.6个月，而NLR持续低的患者为34.8个月（对数秩检验=0.0025；风险比[HR]0.61[95%CI：0.44-0.84]）。NLR持续高的患者中位总生存期（OS）为19.4个月，而NLR持续低的患者为44.0个月（对数秩检验=0.0011；HR 0.54[95%CI：0.38-0.77]）。
从基线到NAC中期NLR持续高是MIBC患者的独立预后因素。
