Post-Radical Cystectomy Survival Outcomes Predicted by Preop NLR
A neutrophil-to-lymphocyte ratio below 3.09 is associated with significantly longer overall and disease-specific survival.
Preoperative neutrophil-to-lymphocyte ratio (NLR) predicts survival outcomes among patients undergoing radical cystectomy (RC) for bladder cancer, researchers reported at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. NLR is predictive regardless of whether patients have had neoadjuvant chemotherapy.
In a retrospective cohort study, Janet B. Kukreja, MD, and colleagues at the University of Texas MD Cancer Center in Houston obtained NLR data from 1435 patients within 30 days prior to undergoing RC. The median follow-up among survivors was 5.9 years. The median overall survival (OS) was 5.2 years.
The cutoff point of presurgery NLR with the strongest association with OS was 3.09. Median OS and disease-specific survival (DSS) were 5.87 and 15.64 years, respectively, among patients with an NLR below 3.09, compared with 4.18 and 7.47 years among those with an NLR of 3.09 or higher, investigators reported in a poster presentation. The 5-year DSS rates were 74% for patients with an NLR below 3.09 and 56% for those with an NLR of 3.09 and above. In multivariate analysis, increasing NLR was associated with significantly higher risks of death from any cause and disease-specific death.
“There has been a surge of interested in predictive markers, especially when it pertains to response to immunotherapy with PD-L1 assays,” co-investigator Ashish Kamat, MD, told Renal & Urology News. “While these are definitely worth pursuing, we should not lose sight of readily available markers of immunologic activity such as the neutrophil to lymphocyte ratio.”
During the study, 917 patients (64%) died and 518 (36%) were alive at last follow-up; 472 patients (33%) died from bladder cancer and 963 (67%) died from other causes or were alive at last follow-up.
Of the 1435 patients, 887 had an NLR below 3.09, and 339 (38.2%) of these patients received neoadjuvant chemotherapy. The remaining 548 patients had an NLR of 3.09 or above, and 247 (45.1%) of them had received neoadjuvant chemotherapy.
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- Kukreja JB, Podolnick JM, Metcalfe MJ, et al. Preoperative neutrophil-to-lymphocyte ratio is significantly associated with survival outcomes in patients undergoing radical cystectomy, regardless of neoadjuvant chemotherapy status. Results presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. Poster Session B, Board G16. Abstract 352.