INTRODUCTION & OBJECTIVES:
Radical cystectomy (RC) is the standard treatment for patients with muscle-invasive bladder cancer (MIBC) and no evidence of metastasis. Despite surgical treatment and improvements in neoadjuvant chemotherapy, a significant proportion of patients develop disease recurrence. Recent studies report neutrophil-to-lymphocyte ratio (NLR) as an useful biomarker of systemic inflammatory response in several cancer types. NLR has been proposed as a prognostic factor for patients with MIBC following RC.
The aim of our study was to evaluate the clinical usefulness of preoperative NLR as a prognostic marker in patients treated with RC for MIBC.
MATERIALS & METHODS:
A retrospective analysis was performed at our institution between January 2013 and January 2021. Baseline clinical, demographic and histopathological features and related outcomes are reported. We established a NLR cut-off value of 3 based on previous publications.
Disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method, and the log-rank test was used to determine significance. Multivariate analysis was performed based on these survival endpoints using a Cox regression. Statistics were evaluated with IBM™ SPSS software, version 23.
RESULTS:
120 patients were included, of which 103 men (86%) and 17 women (14%). Median age at diagnosis was 70 years (range: 40-86). 55 (46%) patients were active smokers, 37 (31%) former smokers and 28 (23%) never smoked.
Median NLR was 2.6. No association was found between NLR and age (p=0.12), gender (p=0.38), smoking status (p=0.45) or comorbidities assessed by Charlson Index (p=0.42). Statistically significant associations were found between NLR > 3 and advanced pathological tumour stages (p=0.02) and lymphovascular invasion (p=0.01).
Survival analysis showed that NLR > 3 was associated with worse DFS (29.6 vs 61.2 months, p=0.001) and OS (36.3 vs 66.0 months, p=0.002). In multivariate analysis, a NLR > 3 was independently associated with both DFS (HR 2.18; 95% CI 1.25-3.82, p=0.006) and OS (HR 2.22; 95% CI 1.24–3.97, p=0.007).
CONCLUSIONS:
MIBC is associated with high morbidity and mortality. Consequently, there is a need to identify predictors of survival. Our results suggest that patients with preoperative NLR > 3 undergoing RC for MIBC have worse outcomes, both DFS and OS. As an easy achievable and not expensive biomarker, NLR can be useful and needs to be validated in risk stratification models.

PREOPERATIVE NEUTROPHIL-TO-LYMPHOCYTE RATIO PREDICTING OUTCOME IN MUSCLE INVASIVE BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.