NEW ORLEANS—Two new studies presented at the American Urological Association annual meeting suggest that an elevated neutrophil to lymphocyte ratio (NLR) may predict a greater likelihood of tumor recurrence in patients who have undergone surgery for non-muscle invasive bladder cancer (NMIBC).

In one study, Vincenzo Favilla, MD, and collaborators at the University of Catania in Italy, prospectively evaluated NLR—which is defined as the absolute neutrophil count divided by the absolute lymphocyte count—in a cohort of 178 patients (mean age 69 years, 148 male and 30 female) newly diagnosed with NMIBC and who underwent transurethral resection of bladder tumor (TURBT). The median follow-up was 53 months. The median NLR was 2.55.

During follow-up, 14 patients with an NLR less than 3 (23.3%) experienced recurrence compared with 44 patients with an NLR of 3 or higher (37.9%). In multivariate analysis, an NLR below 3 was associated with a 66% decreased risk of recurrence compared with an NLR of 3 or higher. The 5-year recurrence-free survival rate was 62% for those with an NLR less than 3 compared with 49% for patients with an NLR of 3 or higher. All of these between-group differences were statistically significant. The study found no significant association between NLR and progression risk.

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In the other study, Emrah Yuruk, MD, of the Bagcilar Training and Research Hospital, Istanbul, Turkey, and colleagues reviewed the medical records of 428 consecutive bladder cancer patients who underwent TURBT. After excluding patients without a preoperative NLR or a minimum of 6 months of follow-up, as well as patients with muscle-invasive disease, the researchers had a study population that included 390 NMIBC patients with a mean age of about 66 years (range 18–95 years). Of these, 68 (17.4%) experienced disease recurrence. These patients had a significantly higher mean NLR than those who did not have recurrence (2.62 vs. 2.20).

The patients with and without recurrence were similar with respect to mean age, gender distribution, and history of hypertension, diabetes, coronary artery disease, and hyperlipidemia.

The investigators noted that it has been shown that NLR may predict progression of NMIBC, its association with NMIBC recurrence has not been studied previously.