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Is neutrophil-to-lymphocytes ratio a clinical relevant preoperative biomarker in upper tract urothelial carcinoma? A meta-analysis of 4385 patients

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Abstract

Background

Preoperative blood-based inflammatory biomarkers have been suggested to improve staging and prognostication in patients with upper-tract urothelial carcinoma (UTUC). Neutrophil-to-lymphocyte ratio (NLR) is the most studied blood-based biomarker. NLR is an indicator of systemic inflammation and has been shown to be associated with a poor prognosis in various malignancies. The aim of this study was to analyze the current evidence regarding the prognostic significance of preoperative NLR in patients undergoing radical nephroureterectomy (RNU) for UTUC to assess its prognostic potential.

Materials and methods

A systematic search of Web of Science, Medline/PubMed and Cochrane library was performed on the 1st of October, 2017. Studies were deemed eligible if they compared patients with high NLR before surgical treatment for UTUC to patients with low NLR to determine its predictive value for survival using multivariable logistic regression analysis. We performed a formal meta-analysis for cancer-specific survival (CSS), recurrence-free survival (RFS) and overall survival (OS).

Results

Nine studies including a total of 4385 patients assessing the importance of NLR were included in this meta-analysis. The cut-off NLR varied in the eligible studies ranging from 2 to 3. Increased pretreatment NLR predicted OS (pooled HR 1.64 95% CI; 1.23–2.17), RFS (pooled HR 1.60 95% CI; 1.16–2.20) and CSS (pooled HR 1.73 95% CI; 1.23–2.44) in multivariable analyses.

Conclusion

In this meta-analysis, preoperative blood-based NLR is associated with worse prognosis in patients who underwent RNU for UTUC. NLR could be used to improve clinical decision making regarding RNU vs. kidney-sparing surgery, extent of lymphadenectomy, perioperative systemic therapy and follow-up schedule.

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Acknowledgements

M.D.V had a EUSP lab/clinical fellowship awarded by EAU (European Association of Urology) and an Ernst Mach Grant awarded by OeAD, Austria. L.V had an ERASMUS + scholarship.

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Author notes

  1. Mihai Dorin Vartolomei and Shoji Kimura contributed equally as first authors.

Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Mihai Dorin Vartolomei, Shoji Kimura, Liliana Vartolomei, Beat Foerster, Mohammad Abufaraj & Shahrokh F. Shariat

  2. Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania

    Mihai Dorin Vartolomei

  3. Division of Urology, European Institute of Oncology, Milan, Italy

    Mihai Dorin Vartolomei & Matteo Ferro

  4. Department of Urology, Jikei University School of Medicine, Tokyo, Japan

    Shoji Kimura

  5. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland

    Beat Foerster

  6. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

  7. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  8. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  9. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

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  1. Mihai Dorin Vartolomei
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Contributions

Protocol/project development: MD Vartolomei, S Kimura, SF Shariat; Data collection or management: MD Vartolomei, S Kimura, L Vartolomei, B Foerster, M Abufaraj; Data analysis: MD Vartolomei, S Kimura, M Ferro, SF Shariat; Manuscript writing/editing: MD Vartolomei, S Kimura, M Ferro, L Vartolomei, B Foerster, M Abufaraj, SF Shariat.

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Correspondence to Shahrokh F. Shariat.

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Vartolomei, M.D., Kimura, S., Ferro, M. et al. Is neutrophil-to-lymphocytes ratio a clinical relevant preoperative biomarker in upper tract urothelial carcinoma? A meta-analysis of 4385 patients. World J Urol 36, 1019–1029 (2018). https://doi.org/10.1007/s00345-018-2235-5

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