Can Neutrophil-to-Lymphocyte ratio predict the response to BCG in high-risk non muscle invasive bladder cancer?

Marco Racioppi, Emilio Sacco, Pierfrancesco Bassi, Mauro Ragonese, Giuseppe Palermo

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HRNMIBC) treated with BCG therapy. Materials and Methods: Between March 2010 and February 2014 in a tertiary center 100 consecutive patients with newly diagnosed HRNMIBC were retrospectively analyzed. Patients were divided according to NLR value: 46 patients with NLR value less than 3 (NLR < 3 group), and 54 patients with NLR value more than 3 (NLR ≥ 3 group). At the end of follow-up 52 patients were high grade disease free (BCG-responder group) and 48 patients underwent radical cystectomy for high grade recurrence or progression to muscle invasive disease (BCG non-responder group). The average follow-up was 60 months. Intervention: analysis and correlation of preoperative NLR value with response to BCG in terms of recurrence and progression. Results: The optimal cut-off for NLR was ≥ 3 according to the receiver operating characteristics analysis (AUC 0.760, 95% CI, 0.669-0.850). Mean NLR value was 3.65 ± 1.16 in BCG non-responder group and 2.61 ± 0.77 in BCG responder group (p = 0.01). NLR correlated with recurrence (r = 0.55, p = 0.01) and progression risk scores (r = 0.49, p = 0.01). In multivariate analysis, NLR (p = 0.02) and EORTC recurrence risk groups (p = 0.01) were associated to the primary endpoint. The log-rank test showed statistically significant difference between NLR < 3 and NLR ≥ 3 curves (p < 0.05). Conclusions: NLR value preoperatively evaluated could be a useful tool to predict BCG response of HRNMIBC. These results could lead to the development of prospective studies to assess the real prognostic value of NLR in HRNMIBC.
Original languageEnglish
Pages (from-to)315-324
Number of pages10
JournalINTERNATIONAL BRAZ J UROL
Volume45
DOIs
Publication statusPublished - 2019

Keywords

  • Adjuvants, Immunologic
  • Aged
  • BCG Vaccine
  • Biomarkers, Tumor
  • Carcinoma, Transitional Cell
  • Cystectomy
  • Disease Progression
  • Female
  • Humans
  • Lymphocyte Count
  • Lymphocytes
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Neutrophils
  • Prognosis
  • Retrospective Studies
  • Urinary Bladder Neoplasms
  • Urinary bladder neoplasms

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