Skip to main content

Advertisement

SpringerLink
Log in

The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with recurrence and poor prognosis in numerous cancer types. The aim of this study was to evaluate the use of the NLR as a biomarker for intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) for the first time.

Methods

We retrospectively analyzed the records of 100 patients with UTUC who had undergone RNU between 1999 and 2015 at our institution. The association between the preoperative NLR and IVR were assessed using multivariate models.

Results

Among the 100 patients enrolled in the study, 33 developed IVR during a median follow-up of 34 months. The receiver operating characteristic analysis revealed that the optimum cut-off value for the preoperative NLR was >3.8. A high preoperative NLR (n = 21) was associated with a significantly increased risk of lymph node involvement (p = 0.036) and IVR (p = 0.034) compared with a low preoperative NLR (n = 79). IVR-free survival in patients with a high preoperative NLR was significantly worse than that of patients with a low preoperative NLR (p = 0.018). On multivariate analysis, the preoperative NLR [hazard ratio (HR) 2.49; p = 0.015] and tumor multifocality (HR 2.96; p = 0.024) were independent risk factors predictive of IVR.

Conclusion

In our study population of patients with UTUC who had undergone RNU the preoperative NLR was associated with a significantly increased risk of IVR, suggesting that the NRL could be a useful biomarker for predicting IVR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Green DA, Rink M, Xylinas E et al (2013) Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol 189:1214–1221

    Article  PubMed  Google Scholar 

  2. Rouprêt M, Babjuk M, Compérat E et al (2015) European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 68:868–879

    Article  PubMed  Google Scholar 

  3. Sanderson KM, Cai J, Miranda G et al (2007) Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup. J Urol 177:2088–2094

    Article  PubMed  Google Scholar 

  4. Terakawa T, Miyake H, Muramaki M et al (2008) Risk factors for intravesical recurrence after surgical management of transitional cell carcinoma of the upper urinary tract. Urology 71:123–127

    Article  PubMed  Google Scholar 

  5. Novara G, De Marco V, Dalpiaz O et al (2008) Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract. BJU Int 101:1368–1374

    Article  PubMed  Google Scholar 

  6. Ku JH, Choi WS, Kwak C et al (2011) Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract. Urol Oncol 29:383–387

    Article  PubMed  Google Scholar 

  7. Xylinas E, Kluth L, Passoni N et al (2014) Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. Eur Urol 65:650–658

    Article  PubMed  Google Scholar 

  8. Liu Y, Lu J, Hong K et al (2014) Independent prognostic factors for initial intravesical recurrence after laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Oncol 32:146–152

    Article  PubMed  Google Scholar 

  9. Seisen T, Granger B, Colin P et al (2015) A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 67:1122–1133

    Article  PubMed  Google Scholar 

  10. Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454:436–444

    Article  CAS  PubMed  Google Scholar 

  11. Whiteside TL (2008) The tumor microenvironment and its role in promoting tumor growth. Oncogene 27:5904–5912

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Yamanaka T, Matsumoto S, Teramukai S et al (2007) The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 73:215–220

    Article  PubMed  Google Scholar 

  13. Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184

    Article  CAS  PubMed  Google Scholar 

  14. Azab B, Bhatt VR, Phookan J et al (2012) Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 19:217–224

    Article  PubMed  Google Scholar 

  15. Ohno Y, Nakashima J, Ohori M et al (2010) Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma. J Urol 184:873–878

    Article  PubMed  Google Scholar 

  16. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  17. Proctor MJ, Morrison DS, Talwar D et al (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer 47:2633–2641

    Article  PubMed  Google Scholar 

  18. Azuma T, Matayoshi Y, Odani K et al (2013) Preoperative neutrophil-lymphocyte ratio as an independent prognostic marker for patients with upper urinary tract urothelial carcinoma. Clin Genitourin Cancer 11:337–341

    Article  PubMed  Google Scholar 

  19. Tanaka N, Kikuchi E, Kanao K et al (2014) A multi-institutional validation of the prognostic value of the neutrophil-to-lymphocyte ratio for upper tract urothelial carcinoma treated with radical nephroureterectomy. Ann Surg Oncol 21:4041–4048

    Article  PubMed  Google Scholar 

  20. Harris AL, Neal DE (1992) Bladder cancer—field versus clonal origin. N Engl J Med 326:759–761

    Article  CAS  PubMed  Google Scholar 

  21. Hinotsu S, Akaza H, Ohashi Y et al (1999) Intravesical chemotherapy for maximum prophylaxis of new early phase superficial bladder carcinoma treated by transurethral resection: a combined analysis of trials by the Japanese Urological Cancer Research Group using smoothed hazard function. Cancer 86:1818–1826

    Article  CAS  PubMed  Google Scholar 

  22. Catto JW, Hartmann A, Stoehr R et al (2006) Multifocal urothelial cancers with the mutator phenotype are of monoclonal origin and require panurothelial treatment for tumor clearance. J Urol 175:2323–2330

    Article  CAS  PubMed  Google Scholar 

  23. Takaoka E, Hinotsu S, Joraku A et al (2010) Pattern of intravesical recurrence after surgical treatment for urothelial cancer of the upper urinary tract: a single institutional retrospective long-term follow-up study. Int J Urol 17:623–628

    Article  PubMed  Google Scholar 

  24. Ito A, Shintaku I, Satoh M et al (2013) Intravesical seeding of upper urinary tract urothelial carcinoma cells during nephroureterectomy: an exploratory analysis from the THPMG trial. Jpn J Clin Oncol 43:1139–1144

    Article  PubMed  Google Scholar 

  25. Cho H, Hur HW, Kim SW et al (2009) Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 58:15–23

    Article  CAS  PubMed  Google Scholar 

  26. De Larco JE, Wuertz BR, Furcht LT (2004) The potential role of neutrophils in promoting the metastatic phenotype of tumors releasing interleukin-8. Clin Cancer Res 10:4895–4900

    Article  PubMed  Google Scholar 

  27. Rodriguez PC, Ernstoff MS, Hernandez C et al (2009) Arginase I-producing myeloid-derived suppressor cells in renal cell carcinoma are a subpopulation of activated granulocytes. Cancer Res 69:1553–1560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Muller I, Munder M, Kropf P et al (2009) Polymorphonuclear neutrophils and T lymphocytes: strange bedfellows or brothers in arms? Trends Immunol 30:522–530

    Article  PubMed  Google Scholar 

  29. Hung HY, Chen JS, Yeh CY et al (2011) Effect of preoperative neutrophil-lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis 26:1059–1065

    Article  PubMed  Google Scholar 

  30. O’Brien T, Ray E, Singh R et al (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60:703–710

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan

    Nozomu Kishimoto, Tetsuya Takao, Sohei Kuribayashi, Gaku Yamamichi, Kosuke Nakano, Masataka Kawamura, Koichi Tsutahara, Go Tanigawa & Seiji Yamaguchi

Authors
  1. Nozomu Kishimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuya Takao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sohei Kuribayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gaku Yamamichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kosuke Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masataka Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koichi Tsutahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Go Tanigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Seiji Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuya Takao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kishimoto, N., Takao, T., Kuribayashi, S. et al. The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy. Int J Clin Oncol 22, 153–158 (2017). https://doi.org/10.1007/s10147-016-1040-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-016-1040-7

Keywords

Search

Navigation