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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

Annals of Surgical Oncology volume 23, pages 1039–1047 (2016)Cite this article

Abstract

Purpose

We speculated that a heterogeneous population of non-muscle invasive bladder cancer (NMIBC) patients with a previous history of smoking may be more precisely stratified by a biomarker associated with tumor aggressiveness and then focused on the preoperative neutrophil-to-lymphocyte ratio (pre-NLR), which is a simple index of systemic inflammation.

Methods

Our study population comprised 605 patients initially diagnosed with NMIBC at our 3 institutions between 1995 and 2013. We analyzed the relationships between pre-NLR levels and clinical outcomes in NMIBC. A pre-NLR level of ≥2.2 was defined as elevated according to a calculation by a receiver-operating curve analysis.

Results

In overall, a total of 296 patients (48.9 %) had pre-NLR ≥ 2.2, and the pre-NLR level was one of independent risk factors for tumor recurrence and stage progression. Among 344 patients with a previous history of smoking, 184 (53.5 %) had pre-NLR ≥ 2.2 and the pre-NLR level was one of independent risk factors for tumor recurrence and stage progression. The 5-year recurrence-free survival and progression-free survival rates in patients with pre-NLR < 2.2 were 66.3 and 97.5 %, respectively, which were significantly higher than those in their counterparts (31.7 and 90.4 %, p < 0.001). In either subgroup of patients who were current smokers (N = 175) or former smokers (N = 169), the pre-NLR level was the only independent risk factor for tumor recurrence. The pre-NLR level was not associated with tumor recurrence or stage progression in 261 nonsmoking patients.

Conclusions

Pre-NLR levels may be a useful marker for identifying worse clinical outcomes in NMIBC patients, particularly those with a previous history of smoking.

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Fig. 1

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Disclosure

All authors certify that this study has no financial or other relationships that 3 institutions might lead to a conflict of interest.

Author information

Affiliations

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

    Koichiro Ogihara MD, Eiji Kikuchi MD, PhD, Kazuyuki Yuge MD, Kazuhiro Matsumoto MD, Akira Miyajima MD, PhD & Mototsugu Oya MD, PhD

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

    Yoshinori Yanai MD

  3. Department of Urology, Saitama Medical University Hospital, Saitama, Japan

    Hirotaka Asakura MD, PhD

Authors
  1. Koichiro Ogihara MD
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  2. Eiji Kikuchi MD, PhD
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  3. Kazuyuki Yuge MD
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  4. Yoshinori Yanai MD
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  5. Kazuhiro Matsumoto MD
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  6. Akira Miyajima MD, PhD
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  7. Hirotaka Asakura MD, PhD
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  8. Mototsugu Oya MD, PhD
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Corresponding author

Correspondence to Eiji Kikuchi MD, PhD.

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Ogihara, K., Kikuchi, E., Yuge, K. et al. 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, 1039–1047 (2016). https://doi.org/10.1245/s10434-016-5578-4

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  • DOI: https://doi.org/10.1245/s10434-016-5578-4

Keywords

  • Tumor Recurrence
  • MIBC
  • Stage Progression
  • Ideal Cutoff
  • Predict Tumor Recurrence