The prognostic role of preoperative circulating neutrophil–lymphocyte ratio in primary bladder cancer patients undergoing radical cystectomy: a meta-analysis
- 82 Downloads
Systemic inflammatory response (SIR) plays important roles in initiation, promotion and progression of tumor. However, the prognostic role of preoperative circulating neutrophil–lymphocyte ratio (NLR) (known as a marker of SIR) in human primary bladder cancer (BC) undergoing radical cystectomy (RC) remains controversial. Hence, we performed this meta-analysis to better understand the role of preoperative circulating NLR in prognosis prediction for primary BC patients undergoing RC.
We searched PubMed, Embase and EBSCO to identify the studies and computed extracted data with STATA 12.0.
A total of 11,945 patients with BC from 18 published studies were incorporated into this meta-analysis. We found that elevated NLR was significantly associated with decreased 3-year and 5-year overall survival (OS), 1-year, 3-year and 5-year recurrence-free survival (RFS), but not with 1-year or 10-year OS, or 10-year RFS in primary BC patients who underwent RC. The results also showed that neoadjuvant chemotherapy (NAC) had a significant impact on the negative prognostic effect of NLR. In addition, high NLR significantly correlated with unfavorable clinicopathological features of BC.
Elevated preoperative circulating NLR leads to an unfavorable outcome in primary BC undergoing RC, especially in patients without NAC, implicating that it might be a valuable prognostic index for these patients.
KeywordsPreoperative circulating neutrophil–lymphocyte ratio Unfavorable outcome Primary bladder cancer Radical cystectomy Neoadjuvant chemotherapy Meta-analysis
Systemic inflammatory response
Tumor, lymph node, metastasis
We thank all the members of the departments who helped in this study.
GH contributed to protocol and project development, data collection and manuscript writing; FX, QX and KZ contributed to data collection; SW and LH contributed to data analysis; PC contributed to protocol and project development and the manuscript revision. All authors read and approved the final manuscript.
This work was funded by the National Natural Science Foundation of China (Grant no. 81702803, GMH).
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest.
Research involving human participants and/or animals
The ethical approval was unnecessary because this study based on summary and analysis of the results of previous studies.
- 7.D’Andrea D, Moschini M, Gust KM, Abufaraj M, Ozsoy M, Mathieu R, Soria F, Briganti A, Roupret M, Karakiewicz PI, Shariat SF (2017) Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio as biomarkers for predicting lymph node metastasis and survival in patients treated with radical cystectomy. J Surg Oncol 115:455–461CrossRefPubMedGoogle Scholar
- 10.Viers BR, Boorjian SA, Frank I, Tarrell RF, Thapa P, Karnes RJ, Thompson RH, Tollefson MK (2014) Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Eur Urol 66:1157–1164CrossRefPubMedGoogle Scholar
- 11.Ogihara K, Kikuchi E, Yuge K, Yanai Y, Matsumoto K, Miyajima A, Asakura H, Oya M (2016) The preoperative neutrophil-to-lymphocyte ratio is a novel biomarker for predicting worse clinical outcomes in non-muscle invasive bladder cancer patients with a previous history of smoking. Ann Surg Oncol 23:1039–1047CrossRefPubMedGoogle Scholar
- 13.Mano R, Baniel J, Shoshany O, Margel D, Bar-On T, Nativ O, Rubinstein J, Halachmi S (2015) Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer. Urol Oncol 33(67):e1–e7Google Scholar
- 15.Hermanns T, Bhindi B, Wei Y, Yu J, Noon AP, Richard PO, Bhatt JR, Almatar A, Jewett MA, Fleshner NE, Zlotta AR, Templeton AJ, Kulkarni GS (2014) Pre-treatment neutrophil-to-lymphocyte ratio as predictor of adverse outcomes in patients undergoing radical cystectomy for urothelial carcinoma of the bladder. Br J Cancer 111:444–451CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Kawahara T, Furuya K, Nakamura M, Sakamaki K, Osaka K, Ito H, Ito Y, Izumi K, Ohtake S, Miyoshi Y, Makiyama K, Nakaigawa N, Yamanaka T, Miyamoto H, Yao M, Uemura H (2016) Neutrophil-to-lymphocyte ratio is a prognostic marker in bladder cancer patients after radical cystectomy. BMC Cancer 16:185CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Hirasawa Y, Nakashima J, Yunaiyama D, Sugihara T, Gondo T, Nakagami Y, Horiguchi Y, Ohno Y, Namiki K, Ohori M, Tokuuye K, Tachibana M (2016) Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy. Ann Surg Oncol 23:1048–1054CrossRefPubMedGoogle Scholar
- 19.Ozcan C, Telli O, Ozturk E, Suer E, Gokce MI, Gulpinar O, Oztuna D, Baltaci S, Gogus C (2015) The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer. Can Urol Assoc J 9:E789–E794CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Buisan O, Orsola A, Areal J, Font A, Oliveira M, Martinez R, Ibarz L (2017) Low pretreatment neutrophil-to-lymphocyte ratio predicts for good outcomes in patients receiving neoadjuvant chemotherapy before radical cystectomy for muscle invasive bladder cancer. Clin Genitourin Cancer 15:145–151 e2CrossRefPubMedGoogle Scholar
- 21.Morizawa Y, Miyake M, Shimada K, Hori S, Tatsumi Y, Nakai Y, Anai S, Tanaka N, Konishi N, Fujimoto K (2016) Neutrophil-to-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy. Urol Oncol 34(257):e11–e17Google Scholar
- 23.Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T, Tachibana M (2012) Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology 79:1085–1091CrossRefPubMedGoogle Scholar
- 24.Yoshida T, Kinoshita H, Yoshida K, Mishima T, Yanishi M, Komai Y, Sugi M, Murota T, Kawa G, Matsuda T (2016) Perioperative change in neutrophil-lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy. Jpn J Clin Oncol 46:1162–1167CrossRefPubMedGoogle Scholar
- 26.van Kessel KE, de Haan LM, Fransen van de Putte EE, van Rhijn BW, de Wit R, van der Heijden MS, Zwarthoff EC, Boormans JL (2016) Elevated derived neutrophil-to-lymphocyte ratio corresponds with poor outcome in patients undergoing pre-operative chemotherapy in muscle-invasive bladder cancer. Bladder Cancer 2:351–360CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Buisan O, Orsola A, Oliveira M, Martinez R, Etxaniz O, Areal J, Ibarz L (2017) Role of inflammation in the perioperative management of urothelial bladder cancer with squamous-cell features: impact of neutrophil-to-lymphocyte ratio on outcomes and response to neoadjuvant chemotherapy. Clin Genitourin Cancer 14:e697–e706CrossRefGoogle Scholar
- 29.Mbeutcha A, Shariat SF, Rieken M, Rink M, Xylinas E, Seitz C, Lucca I, Mathieu R, Roupret M, Briganti A, Karakiewicz PI, Klatte T (2016) Prognostic significance of markers of systemic inflammatory response in patients with non-muscle-invasive bladder cancer. Urol Oncol 34:483 e17–483 e24CrossRefGoogle Scholar
- 33.Lucca I, Jichlinski P, Shariat SF, Roupret M, Rieken M, Kluth LA, Rink M, Mathieu R, Mbeutcha A, Maj-Hes A, Fajkovic H, Briganti A, Seitz C, Karakiewicz PI, de Martino M, Lotan Y, Babjuk M, Klatte T (2016) The neutrophil-to-lymphocyte ratio as a prognostic factor for patients with urothelial carcinoma of the bladder following radical cystectomy: validation and meta-analysis. Eur Urol Focus 2:79–85CrossRefPubMedGoogle Scholar