Zattoni Fabio, Novara Giacomo, Iafrate Massimo, Carletti Filippo, Reitano Giuseppe, Randazzo Gianmarco, Ceccato Tommaso, Betto Giovanni, Dal Moro Fabrizio
Department of Surgery, Oncology, and Gastroenterology, Urological Unit, University of Padova, Padova, Italy.
Cent European J Urol. 2023;76(2):90-103. doi: 10.5173/ceju.2023.039. Epub 2023 May 12.
The pre-treatment neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse pathology or survival in a variety of malignancies, including urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Whether the prognostic value of NLR is retained, or even increased, when measured postoperatively remains to be studied. In this study, we evaluated the association of preoperative and postoperative NLR with oncological outcomes following RC.
The NLR was recorded in 132 consecutive patients with UCB treated with open RC: before surgery (NLR1), postoperatively within 2 days (NRL2), between 7 and 15 days after RC before discharge (NLR3), and a few days before recurrence or last available follow-up (NLR4).
When assessed by multivariate analysis NLR1 remained independently associated with a significantly increased risk of extravesical disease (pT 3-4) (OR = 1.4, p <0.01) and lymphovascular invasion (LVI) (OR = 1.40, 95% CI 1.09-1.83, p <0.01). NLR4 was independently associated with a significantly increased risk of cancer-specific mortality (CSM) (HR = 1.14, 95%CI 1.03-1.24, p = 0.013). In a postoperative model, NLR3 was found to be an independent predictor of all-cause mortality (ACM) [HR = 1.11, 95% CI 1.02-1.21, p = 0.01]. NLR1 was associated with a significantly increased risk of recurrence in the univariable preoperative model [HR = 1.9, 95%CI 1.00-3.65, p = 0.05], while in the postoperative model NLR4 remained independently associated with a significantly increased risk of recurrence (HR = 1.13, 95%CI 1.04-1.23, p = 0.03).
In patients with UCB treated with RC, the NLR is associated with more advanced tumour stage, LVI, lymph node metastasis, and higher CSM. Furthermore, the variation of the NLR after surgery might play a role in predicting higher ACM and recurrence-free survival.
治疗前中性粒细胞与淋巴细胞比值（NLR）与多种恶性肿瘤的不良病理或生存率相关，包括接受根治性膀胱切除术（RC）治疗的膀胱尿路上皮癌（UCB）。术后测量时NLR的预后价值是否保留甚至增加仍有待研究。在本研究中，我们评估了术前和术后NLR与RC术后肿瘤学结局的相关性。
记录了132例连续接受开放性RC治疗的UCB患者的NLR：手术前（NLR1）、术后2天内（NRL2）、RC术后7至15天出院前（NLR3）以及复发前或最后一次随访前几天（NLR4）。
通过多变量分析评估时，NLR1仍然独立地与膀胱外疾病（pT 3-4）风险显著增加（OR = 1.4，p <0.01）和淋巴管浸润（LVI）相关（OR = 1.40，95%CI 1.09-1.83，p <0.01）。NLR4独立地与癌症特异性死亡率（CSM）风险显著增加相关（HR = 1.14，95%CI 1.03-1.24，p = 0.013）。在术后模型中，发现NLR3是全因死亡率（ACM）的独立预测因子[HR = 1.11，95%CI 1.02-1.21，p = 0.01]。在单变量术前模型中，NLR1与复发风险显著增加相关[HR = 1.9，95%CI 1.00-3.65，p = 0.05]，而在术后模型中，NLR4仍然独立地与复发风险显著增加相关（HR = 1.13，95%CI 1.04-1.23，p = 0.03）。
在接受RC治疗的UCB患者中，NLR与更晚期肿瘤分期、LVI、淋巴结转移和更高的CSM相关。此外，术后NLR的变化可能在预测更高的ACM和无复发生存率方面发挥作用。
