Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Division of Urology, European Institute of Oncology, Milan, Italy.
Clin Genitourin Cancer. 2018 Dec;16(6):445-452. doi: 10.1016/j.clgc.2018.07.003. Epub 2018 Jul 6.
The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC).
The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS).
A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%).
Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.
本多中心研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）的预后作用，并在原发性 T1HG/G3 非肌层浸润性膀胱癌（NMIBC）的大型多机构队列中验证 NLR 为 3 的截断值。
研究时间为 2002 年 1 月至 2012 年 12 月。共纳入 1046 例在经尿道膀胱肿瘤切除术（TURB）时患有原发性 T1HG/G3、NMIBC 且在 13 个学术机构接受辅助膀胱内卡介苗治疗并维持治疗的患者。终点是疾病时间、无复发生存（RFS）、无进展生存（PFS）、总生存（OS）和癌症特异性生存（CSS）。
共有 512 例（48.9%）患者在 TURB 前 NLR≥3。高预处理 NLR 与女性性别和 TURB 后残留 T1HG/G3 相关。NLR≥3 的患者 5 年 RFS 估计值为 9.4%（95%置信区间[CI]，6.8%-12.4%），而 NLR<3 的患者为 58.8%（95%CI，54%-63.2%）；5 年 PFS 估计值分别为 57.1%（95%CI，51.5%-62.2%）和 79.2%（95%CI，74.7%-83%；P<0.0001）；10 年 OS 估计值分别为 63.6%（95%CI，55%-71%）和 66.5%（95%CI，56.8%-74.5%；P=0.03）；10 年 CSS 估计值分别为 77.4%（95%CI，68.4%-84.2%）和 84.3%（95%CI，76.6%-89.7%；P=0.004）。NLR 与疾病复发（危险比[HR]，3.34；95%CI，2.82-3.95；P<0.001）、进展（HR，2.18；95%CI，1.71-2.78；P<0.001）和 CSS（HR，1.65；95%CI，1.02-2.66；P=0.03）独立相关。NLR 加入到包括既定特征的多变量模型中增加了其对 RFS（+6.9%）、PFS（+1.8%）和 CSS（+1.7%）预测的区分度。
原发性 T1HG/G3 NMIBC 患者治疗前 NLR≥3 是 RFS、PFS 和 CSS 的强烈预测因子。它可以帮助在治疗强度和随访方面做出决策。
