The prognostic role of preoperative circulating neutrophil–lymphocyte ratio in primary bladder cancer patients undergoing radical cystectomy: a meta-analysis

  • Guoming HuEmail author
  • Feng Xu
  • Kefang Zhong
  • Shimin Wang
  • Qi Xu
  • Liming Huang
  • Pu ChengEmail author
Original Article



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.


Preoperative circulating neutrophil–lymphocyte ratio Unfavorable outcome Primary bladder cancer Radical cystectomy Neoadjuvant chemotherapy Meta-analysis 



Neutrophil–lymphocyte ratio


Systemic inflammatory response


Bladder cancer


Radical cystectomy


Neoadjuvant chemotherapy


Overall survival


Recurrence-free survival


Hazard rations


Odds ratios


Confidence interval


Tumor, lymph node, metastasis


Not reported



We thank all the members of the departments who helped in this study.

Author contributions

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

Human participants.

Informed consent

The ethical approval was unnecessary because this study based on summary and analysis of the results of previous studies.

Supplementary material

345_2018_2593_MOESM1_ESM.pdf (657 kb)
Supplementary material 1 (PDF 657 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General Surgery (Breast and Thyroid Surgery)Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine)ShaoxingChina
  2. 2.Department of NephrologyShaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine)ShaoxingChina
  3. 3.Department of Surgical OncologyShaoxing Second HospitalShaoxingChina
  4. 4.Department of Gynecology, Second Affiliated Hospital, Zhejiang University School of MedicineZhejiang UniversityHangzhouChina

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