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A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

Annals of Surgical Oncology volume 21, pages 4041–4048 (2014)Cite this article

Abstract

Background

To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).

Methods

A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.

Results

Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (p < 0.001) and 60.2 % (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (p = 0.041) and 83.0 % (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).

Conclusion

This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.

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Acknowledgment

Members of the Keio Collaboration Study of Urothelial Carcinoma participated in this study: Keishiro Fukumoto, Keio University School of Medicine, Tokyo, Japan; So Nakamura, Saiseikai Central Hospital, Tokyo, Japan; Takeshi Masuda, Saitama Municipal Hospital, Saitama, Japan; Shintaro Hasegawa, National Hospital Organization Tochigi Hospital, Tochigi, Japan; Atsushi Uchida, Kyosai Tachikawa Hospital, Tokyo, Japan; Kazuhiko Nagakura, Musashino Yowakai Hospital, Tokyo, Japan; Masakazu Ohashi, Ogikubo Hospital, Tokyo, Japan; Shoji Matsuzaki, Inagi Municipal Hospital, Tokyo, Japan; Kazutoyo Miyata, Irumagawa Hospital, Saitama, Japan. This work was supported in part by Grants-in-Aid for Scientific Research (#26462429 to Nobuyuki Tanaka) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.

Conflict of interest

This work had no specific funding or financial support.

Author information

Affiliations

  1. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Nobuyuki Tanaka MD, Eiji Kikuchi MD, PhD, Kent Kanao MD, PhD, Kazuhiro Matsumoto MD, Suguru Shirotake MD, PhD, Yasumasa Miyazaki MD, Hiroaki Kobayashi, Gou Kaneko MD, Masayuki Hagiwara MD, Hiroki Ide MD, Jun Obata MD, Katsura Hoshino MD, Nozomi Hayakawa MD, Takeo Kosaka MD, PhD & Mototsugu Oya MD, PhD

  2. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan

    Kazuhiro Matsumoto MD & Nozomi Hayakawa MD

  3. Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Hidaka, Japan

    Suguru Shirotake MD, PhD & Masafumi Oyama MD, PhD

  4. Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan

    Tetsuo Momma MD, PhD

  5. Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

    Yosuke Nakajima MD, PhD

  6. Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan

    Hiroaki Kobayashi

  7. Department of Urology, Kawasaki City Hospital, Tokyo, Japan

    Gou Kaneko MD & Satoshi Hara MD, PhD

  8. Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan

    Nobuyuki Tanaka MD

  9. Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan

    Masayuki Hagiwara MD

  10. Department of Urology, Ogikubo Hospital, Tokyo, Japan

    Yasumasa Miyazaki MD

  11. Department of Urology, Inagi City Hospital, Tokyo, Japan

    Hiroki Ide MD

  12. Department of Urology, Irumagawa Hospital, Saitama, Japan

    Takeo Kosaka MD, PhD

  13. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan

    Masahiro Jinzaki MD, PhD

Authors
  1. Nobuyuki Tanaka MD
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  2. Eiji Kikuchi MD, PhD
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  3. Kent Kanao MD, PhD
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  4. Kazuhiro Matsumoto MD
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  5. Suguru Shirotake MD, PhD
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  6. Yasumasa Miyazaki MD
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  7. Hiroaki Kobayashi
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  8. Gou Kaneko MD
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  9. Masayuki Hagiwara MD
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  10. Hiroki Ide MD
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  11. Jun Obata MD
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  12. Katsura Hoshino MD
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  13. Nozomi Hayakawa MD
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  14. Takeo Kosaka MD, PhD
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  15. Satoshi Hara MD, PhD
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  16. Masafumi Oyama MD, PhD
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  17. Tetsuo Momma MD, PhD
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  18. Yosuke Nakajima MD, PhD
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  19. Masahiro Jinzaki MD, PhD
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  20. Mototsugu Oya MD, PhD
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Corresponding author

Correspondence to Eiji Kikuchi MD, PhD.

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Tanaka, N., Kikuchi, E., Kanao, K. et al. 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 (2014). https://doi.org/10.1245/s10434-014-3830-3

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  • DOI: https://doi.org/10.1245/s10434-014-3830-3

Keywords

  • Urothelial Carcinoma
  • Radical Nephroureterectomy
  • Predict Disease Recurrence
  • Urothelial Carcinoma Patient
  • Subsequent Disease Recurrence