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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2014

01-11-2014 | Urologic Oncology

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

Authors: 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, Satoshi Hara, MD, PhD, Masafumi Oyama, MD, PhD, Tetsuo Momma, MD, PhD, Yosuke Nakajima, MD, PhD, Masahiro Jinzaki, MD, PhD, Mototsugu Oya, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2014

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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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Metadata
Title
A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy
Authors
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
Satoshi Hara, MD, PhD
Masafumi Oyama, MD, PhD
Tetsuo Momma, MD, PhD
Yosuke Nakajima, MD, PhD
Masahiro Jinzaki, MD, PhD
Mototsugu Oya, MD, PhD
Publication date
01-11-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3830-3

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