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

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Abstract

Background

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.

Methods

We searched PubMed, Embase and EBSCO to identify the studies and computed extracted data with STATA 12.0.

Results

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.

Conclusion

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.

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Abbreviations

NLR:

Neutrophil–lymphocyte ratio

SIR:

Systemic inflammatory response

BC:

Bladder cancer

RC:

Radical cystectomy

NAC:

Neoadjuvant chemotherapy

OS:

Overall survival

RFS:

Recurrence-free survival

HR:

Hazard rations

OR:

Odds ratios

Cl:

Confidence interval

TNM:

Tumor, lymph node, metastasis

NR:

Not reported

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Acknowledgements

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

Funding

This work was funded by the National Natural Science Foundation of China (Grant no. 81702803, GMH).

Author information

Author notes

  1. Co-first authors: Guoming Hu and Feng Xu.

Authors and Affiliations

  1. Department of General Surgery (Breast and Thyroid Surgery), Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, Zhejiang, China

    Guoming Hu, Feng Xu, Kefang Zhong & Liming Huang

  2. Department of Nephrology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, Zhejiang, China

    Shimin Wang

  3. Department of Surgical Oncology, Shaoxing Second Hospital, Shaoxing, 312000, Zhejiang, China

    Qi Xu

  4. Department of Gynecology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310009, China

    Pu Cheng

Authors
  1. Guoming Hu
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  4. Shimin Wang
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  5. Qi Xu
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  7. Pu Cheng
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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.

Corresponding authors

Correspondence to Guoming Hu or Pu Cheng.

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The authors report no conflict of interest.

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

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Hu, G., Xu, F., Zhong, K. et al. The prognostic role of preoperative circulating neutrophil–lymphocyte ratio in primary bladder cancer patients undergoing radical cystectomy: a meta-analysis. World J Urol 37, 1817–1825 (2019). https://doi.org/10.1007/s00345-018-2593-z

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  • DOI: https://doi.org/10.1007/s00345-018-2593-z

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