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Annals of Surgical Oncology

, Volume 23, Issue 1, pp 335–342 | Cite as

The Prognostic Significance of the Early Postoperative Neutrophil-to-Lymphocyte Ratio in Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy

  • Minyong Kang
  • Chang Wook Jeong
  • Cheol Kwak
  • Hyeon Hoe Kim
  • Ja Hyeon Ku
Urologic Oncology

Abstract

Purpose

Because the pretreatment neutrophil-to-lymphocyte ratio (NLR) is a reliable prognostic factor, the authors of this study hypothesized that posttreatment NLR also predicts the survival outcome for cancer patients. The study investigated the clinicopathologic features according to postoperative NLR and determined the prognostic significance of early postoperative NLR for bladder cancer patients undergoing radical cystectomy (RC).

Methods

The study reviewed 385 bladder cancer patients treated with RC and pelvic lymph node dissection at the authors’ institution between 1999 and 2012. The primary end points of the study were cancer-specific survival (CSS) and overall survival (OS) estimates from the Kaplan–Meier analysis. Multivariate Cox regression analysis was adopted to identify the independent prognostic factors for oncologic outcomes after surgery.

Results

Patients with elevated postoperative NLR (≥2.0) had higher rates of advanced pathologic tumor stage (≥pT3), lymphovascular invasion, and lymph node involvement. Notably, they showed poorer CSS and OS rates than patients with a postoperative NLR lower than 2.0. Additionally, patients with pre- and postoperative elevated NLR (≥2.1 → ≥2.0) demonstrated worse oncologic outcomes than other groups of NLR changes. Multivariate analysis showed that early postoperative NLR remained a key predictor for CSS and OS. When divided by pathologic T or N stage, patients with localized pathologic T stage or pN0 status showed significant differences in survival according to early postoperative NLR.

Conclusion

In summary, postoperative NLR in the early recovery period can be a valuable biomarker for predicting oncologic outcomes for bladder cancer patients undergoing RC.

Keywords

Overall Survival Bladder Cancer Oncologic Outcome Radical Cystectomy Pelvic Lymph Node Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

There are no conflicts of interest.

Supplementary material

10434_2015_4708_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)
10434_2015_4708_MOESM2_ESM.tif (238 kb)
Supplemetary Figure S1. Comparison of (A) cancer-specific survival and (B) overall survival, as estimated using Kaplan-Meier analysis, in patients with bladder cancer undergoing radical cystectomy, based on the preoperative neutrophil-to-lymphocyte ratio (NLR) values (<2.1 versus ≥2.1). The log-rank test was adopted to evaluate the statistical differences between the two groups (TIFF 238 kb)
10434_2015_4708_MOESM3_ESM.tif (290 kb)
Supplemetary Figure S2. Comparison of (A) cancer-specific survival and (B) overall survival, as estimated using Kaplan-Meier analysis, in bladder cancer patients treated with radical cystectomy, according to the pre- to post-operative neutrophil-to-lymphocyte ratio (NLR) changes. Based on the NLR changes, patients were divided into three groups as follows: (1) low NLR to low NLR (<2.1 → <2.0); (2) low NLR to high NLR and vice versa (<2.1 → ≥2.0 or ≥2.1 → <2.0; (3) ≥2.1 → ≥2.0). The log-rank test was used to determine significant differences between these groups (TIFF 289 kb)
10434_2015_4708_MOESM4_ESM.tif (484 kb)
Supplemetary Figure S3. Comparison of (A) cancer-specific survival of patients with (a) pT2≤ and (b) pT3> and (B) overall survival of patients with (a) pT2≤ and (b) pT3>, as estimated using Kaplan-Meier analysis, in patients with bladder cancer undergoing radical cystectomy, based on pre- to post-operative neutrophil-to-lymphocyte ratio (NLR) changes. By the NLR changes, patients were divided into three groups as follows: (1) low NLR to low NLR (<2.1 → <2.0); (2) low NLR to high NLR and vice versa (<2.1 → ≥2.0 or ≥2.1 → <2.0; (3) ≥2.1 → ≥2.0). The log-rank test was used to determine significant differences between these groups (TIFF 483 kb)
10434_2015_4708_MOESM5_ESM.tif (443 kb)
Supplemetary Figure S4. Comparison of (A) cancer-specific survival of patients with (a) pN0 and (b) pN1-3 and (B) overall survival of patients with (a) pN0 and (b) pN1-3, as estimated using Kaplan-Meier analysis, in patients with bladder cancer undergoing radical cystectomy, based on postoperative neutrophil-to-lymphocyte ratio (NLR) values (<2.0 versus ≥2.0). The log-rank test was adopted to determine statistical differences between the two groups (TIFF 443 kb)
10434_2015_4708_MOESM6_ESM.tif (491 kb)
Supplemetary Figure S5. Comparison of (A) cancer-specific survival of patients with (a) pN0 and (b) pN1-3 and (B) overall survival of patients with (a) pN0 and (b) pN1-3, as estimated using Kaplan-Meier analysis, in patients with bladder cancer undergoing radical cystectomy, according to the pre- to post-operative neutrophil-to-lymphocyte ratio (NLR) changes. Based on their NLR changes, patients were divided into three groups as follows: (1) low NLR to low NLR (<2.1 → <2.0); (2) low NLR to high NLR and vice versa (<2.1 → ≥2.0 or ≥2.1 → <2.0; (3) ≥2.1 → ≥2.0). The log-rank test was used to determine significant differences between these groups (TIFF 490 kb)

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Minyong Kang
    • 1
  • Chang Wook Jeong
    • 2
  • Cheol Kwak
    • 2
  • Hyeon Hoe Kim
    • 2
  • Ja Hyeon Ku
    • 2
  1. 1.Department of UrologySeoul National University Bundang HospitalSeongnam CityRepublic of Korea
  2. 2.Department of UrologySeoul National University HospitalSeoulRepublic of Korea

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