Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Urology
Published in: World Journal of Urology 9/2019

01-09-2019 | Original Article

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

Authors: Guoming Hu, Feng Xu, Kefang Zhong, Shimin Wang, Qi Xu, Liming Huang, Pu Cheng

Published in: World Journal of Urology | Issue 9/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Albayrak S, Zengin K, Tanik S, Atar M, Unal SH, Imamoglu MA, Gurdal M (2016) Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer? Kaohsiung J Med Sci 32:327–333CrossRefPubMed
2.
Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed
3.
4.
Kuritz SJ, Landis JR, Koch GG (1988) A general overview of Mantel–Haenszel methods: applications and recent developments. Annu Rev Public Health 9:123–160CrossRefPubMed
5.
DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28:105–114CrossRefPubMed
6.
7.
D’Andrea D, Moschini M, Gust KM, Abufaraj M, Ozsoy M, Mathieu R, Soria F, Briganti A, Roupret M, Karakiewicz PI, Shariat SF (2017) Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio as biomarkers for predicting lymph node metastasis and survival in patients treated with radical cystectomy. J Surg Oncol 115:455–461CrossRefPubMed
8.
Zhang GM, Zhu Y, Luo L, Wan FN, Zhu YP, Sun LJ, Ye DW (2015) Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumour Biol 36:8537–8543CrossRefPubMed
9.
Kang M, Jeong CW, Kwak C, Kim HH, Ku JH (2016) The prognostic significance of the early postoperative neutrophil-to-lymphocyte ratio in patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Ann Surg Oncol 23:335–342CrossRefPubMed
10.
Viers BR, Boorjian SA, Frank I, Tarrell RF, Thapa P, Karnes RJ, Thompson RH, Tollefson MK (2014) Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Eur Urol 66:1157–1164CrossRefPubMed
11.
Ogihara K, Kikuchi E, Yuge K, Yanai Y, Matsumoto K, Miyajima A, Asakura H, Oya M (2016) 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 23:1039–1047CrossRefPubMed
12.
Favilla V, Castelli T, Urzi D, Reale G, Privitera S, Salici A, Russo GI, Cimino S, Morgia G (2016) Neutrophil to lymphocyte ratio, a biomarker in non-muscle invasive bladder cancer: a single-institutional longitudinal study. Int Braz J Urol 42:685–693CrossRefPubMedPubMedCentral
13.
Mano R, Baniel J, Shoshany O, Margel D, Bar-On T, Nativ O, Rubinstein J, Halachmi S (2015) Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer. Urol Oncol 33(67):e1–e7
14.
Ojerholm E, Smith A, Hwang WT, Baumann BC, Tucker KN, Lerner SP, Mamtani R, Boursi B, Christodouleas JP (2017) Neutrophil-to-lymphocyte ratio as a bladder cancer biomarker: assessing prognostic and predictive value in SWOG 8710. Cancer 123:794–801CrossRefPubMed
15.
Hermanns T, Bhindi B, Wei Y, Yu J, Noon AP, Richard PO, Bhatt JR, Almatar A, Jewett MA, Fleshner NE, Zlotta AR, Templeton AJ, Kulkarni GS (2014) Pre-treatment neutrophil-to-lymphocyte ratio as predictor of adverse outcomes in patients undergoing radical cystectomy for urothelial carcinoma of the bladder. Br J Cancer 111:444–451CrossRefPubMedPubMedCentral
16.
Kawahara T, Furuya K, Nakamura M, Sakamaki K, Osaka K, Ito H, Ito Y, Izumi K, Ohtake S, Miyoshi Y, Makiyama K, Nakaigawa N, Yamanaka T, Miyamoto H, Yao M, Uemura H (2016) Neutrophil-to-lymphocyte ratio is a prognostic marker in bladder cancer patients after radical cystectomy. BMC Cancer 16:185CrossRefPubMedPubMedCentral
17.
Hirasawa Y, Nakashima J, Yunaiyama D, Sugihara T, Gondo T, Nakagami Y, Horiguchi Y, Ohno Y, Namiki K, Ohori M, Tokuuye K, Tachibana M (2016) Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy. Ann Surg Oncol 23:1048–1054CrossRefPubMed
18.
Kang M, Jeong CW, Kwak C, Kim HH, Ku JH (2017) Preoperative neutrophil-lymphocyte ratio can significantly predict mortality outcomes in patients with non-muscle invasive bladder cancer undergoing transurethral resection of bladder tumor. Oncotarget 8:12891–12901PubMed
19.
Ozcan C, Telli O, Ozturk E, Suer E, Gokce MI, Gulpinar O, Oztuna D, Baltaci S, Gogus C (2015) The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer. Can Urol Assoc J 9:E789–E794CrossRefPubMedPubMedCentral
20.
Buisan O, Orsola A, Areal J, Font A, Oliveira M, Martinez R, Ibarz L (2017) Low pretreatment neutrophil-to-lymphocyte ratio predicts for good outcomes in patients receiving neoadjuvant chemotherapy before radical cystectomy for muscle invasive bladder cancer. Clin Genitourin Cancer 15:145–151 e2CrossRefPubMed
21.
Morizawa Y, Miyake M, Shimada K, Hori S, Tatsumi Y, Nakai Y, Anai S, Tanaka N, Konishi N, Fujimoto K (2016) Neutrophil-to-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy. Urol Oncol 34(257):e11–e17
22.
Tan YG, Eu E, Lau Kam On W, Huang HH (2017) Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer. Asian J Urol 4:239–246CrossRefPubMedPubMedCentral
23.
Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T, Tachibana M (2012) Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology 79:1085–1091CrossRefPubMed
24.
Yoshida T, Kinoshita H, Yoshida K, Mishima T, Yanishi M, Komai Y, Sugi M, Murota T, Kawa G, Matsuda T (2016) Perioperative change in neutrophil-lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy. Jpn J Clin Oncol 46:1162–1167CrossRefPubMed
25.
Ozyalvacli ME, Ozyalvacli G, Kocaaslan R, Cecen K, Uyeturk U, Kemahli E, Gucuk A (2015) Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer. Can Urol Assoc J 9:E126–E131CrossRefPubMedPubMedCentral
26.
van Kessel KE, de Haan LM, Fransen van de Putte EE, van Rhijn BW, de Wit R, van der Heijden MS, Zwarthoff EC, Boormans JL (2016) Elevated derived neutrophil-to-lymphocyte ratio corresponds with poor outcome in patients undergoing pre-operative chemotherapy in muscle-invasive bladder cancer. Bladder Cancer 2:351–360CrossRefPubMedPubMedCentral
27.
Buisan O, Orsola A, Oliveira M, Martinez R, Etxaniz O, Areal J, Ibarz L (2017) Role of inflammation in the perioperative management of urothelial bladder cancer with squamous-cell features: impact of neutrophil-to-lymphocyte ratio on outcomes and response to neoadjuvant chemotherapy. Clin Genitourin Cancer 14:e697–e706CrossRef
28.
Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK (2013) Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy. J Endourol 27:1046–1050CrossRefPubMed
29.
Mbeutcha A, Shariat SF, Rieken M, Rink M, Xylinas E, Seitz C, Lucca I, Mathieu R, Roupret M, Briganti A, Karakiewicz PI, Klatte T (2016) Prognostic significance of markers of systemic inflammatory response in patients with non-muscle-invasive bladder cancer. Urol Oncol 34:483 e17–483 e24CrossRef
30.
D’Andrea D, Moschini M, Gust K, Abufaraj M, Ozsoy M, Mathieu R, Soria F, Briganti A, Roupret M, Karakiewicz PI, Shariat SF (2017) Prognostic role of neutrophil-to-lymphocyte ratio in primary non-muscle-invasive bladder cancer. Clin Genitourin Cancer 15:e755–e764CrossRefPubMed
31.
32.
Li X, Ma X, Tang L, Wang B, Chen L, Zhang F, Zhang X (2017) Prognostic value of neutrophil-to-lymphocyte ratio in urothelial carcinoma of the upper urinary tract and bladder: a systematic review and meta-analysis. Oncotarget 8:62681–62692PubMed
33.
Lucca I, Jichlinski P, Shariat SF, Roupret M, Rieken M, Kluth LA, Rink M, Mathieu R, Mbeutcha A, Maj-Hes A, Fajkovic H, Briganti A, Seitz C, Karakiewicz PI, de Martino M, Lotan Y, Babjuk M, Klatte T (2016) The neutrophil-to-lymphocyte ratio as a prognostic factor for patients with urothelial carcinoma of the bladder following radical cystectomy: validation and meta-analysis. Eur Urol Focus 2:79–85CrossRefPubMed
34.
Tang X, Du P, Yang Y (2017) The clinical use of neutrophil-to-lymphocyte ratio in bladder cancer patients: a systematic review and meta-analysis. Int J Clin Oncol 22:817–825CrossRefPubMed
35.
Tachibana M, Miyakawa A, Tazaki H, Nakamura K, Kubo A, Hata J, Nishi T, Amano Y (1995) Autocrine growth of transitional cell carcinoma of the bladder induced by granulocyte-colony stimulating factor. Cancer Res 55:3438–3443PubMed
36.
Swierczak A, Mouchemore KA, Hamilton JA, Anderson RL (2015) Neutrophils: important contributors to tumor progression and metastasis. Cancer Metastasis Rev 34:735–751CrossRefPubMed
37.
Metadata
Title
The prognostic role of preoperative circulating neutrophil–lymphocyte ratio in primary bladder cancer patients undergoing radical cystectomy: a meta-analysis
Authors
Guoming Hu
Feng Xu
Kefang Zhong
Shimin Wang
Qi Xu
Liming Huang
Pu Cheng
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 9/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2593-z

Other articles of this Issue 9/2019

World Journal of Urology 9/2019 Go to the issue

Original Article

A newly developed porcine training model for transurethral piecemeal and en bloc resection of bladder tumour

Letter to Editor

Furthering the external validity of Aquablation and implications for real-world patients

Original Article

Lower urinary tract symptoms treatment constraints assessment (LUTS-TCA): a new tool for a global evaluation of neurogenic bladder treatments

Topic Paper

The current role and future directions of circulating tumor cells and circulating tumor DNA in urothelial carcinoma of the bladder

Letter to Editor

Alpha-blockers are widely used in medical expulsion therapy for ureteral stones besides management of lower urinary tract symptoms

Editorial

Hope, hype and biology: the current biomarker landscape in bladder cancer