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The prognostic role of the change in neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: A retrospective, multi-institutional sudy

The prognostic role of the change in neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: A retrospective, multi-institutional sudy
The prognostic role of the change in neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: A retrospective, multi-institutional sudy

Background: The impact of the change in the neutrophil-to-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NAC) on outcomes in patients with muscle-invasive bladder cancer (MIBC) is poorly understood.

Objective: To evaluate the prognostic impact of the change in NLR during NAC for patients with MIBC.

Methods: Patients referred to academic, community, and quaternary referral centres in Alberta, Canada from 2005 to 2015, Ontario, Canada from 2005 to 2013, and Southampton, UK from 2004 to 2010 were evaluated. 376 eligible patients were treated with NAC for clinical T2-4aN0M0 disease, and 296 were evaluable for the change in NLR. A high NLR was defined as being an NLR > 3. Relationships between the change in NLR from baseline to mid-NAC (pre-cycle 3) and outcomes were analyzed using multivariable Cox regression. Kaplan-Meier analysis was used with the log-rank test for group comparisons.

Results: Median follow-up was 22.0 months (95% confidence interval [CI]: 14.9-30.0). Patients with a sustained high NLR had a median disease-free survival (DFS) of 12.6 months, compared to 34.8 months for those with a sustained low NLR (log-rank test p = 0.0025; hazard ratio [HR] 0.61 [95% CI: 0.44-0.84]). Median overall survival (OS) was 19.4 months for patients with a sustained high NLR, compared to 44.0 months for patients with a sustained low NLR (log-rank test p = 0.0011; HR 0.54 [95% CI: 0.38-0.77]).

Conclusions: A sustained high NLR from baseline to mid-NAC is an independent prognostic factor for patients with MIBC.

Journal Article
2352-3727
185-194
Kaiser, Jeenan
efeda49d-3436-4b42-82bb-54801a6986d3
Li, Haocheng
d2b75910-6883-4363-a7fb-2b8bc027933c
North, Scott A.
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Leibowitz-Amit, Raya
94c14478-71f4-405b-90ce-c7dfadbf1005
Seah, Jo-An
120f2a61-3818-483a-bd1d-51b887f60fc4
Morshed, Nisha
759fd327-a43b-4a1f-a038-9b092cc5ee8e
Chau, Caroline
eee5b8a2-0843-432c-9f3a-abbe6e6e23f4
Lee-Ying, Richard
8a2e2798-9f5b-4937-bd57-c7e437869162
Heng, Daniel Y.C.
dd68fb74-d03b-48cc-bd13-43be2fbe4b88
Sridhar, Srikala
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Crabb, Simon J.
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Alimohamed, Nimira S.
34266043-ff00-48f8-8847-62398303b317
Kaiser, Jeenan
efeda49d-3436-4b42-82bb-54801a6986d3
Li, Haocheng
d2b75910-6883-4363-a7fb-2b8bc027933c
North, Scott A.
f1f9d9ae-de1c-429b-bbf6-7d5a947c4b88
Leibowitz-Amit, Raya
94c14478-71f4-405b-90ce-c7dfadbf1005
Seah, Jo-An
120f2a61-3818-483a-bd1d-51b887f60fc4
Morshed, Nisha
759fd327-a43b-4a1f-a038-9b092cc5ee8e
Chau, Caroline
eee5b8a2-0843-432c-9f3a-abbe6e6e23f4
Lee-Ying, Richard
8a2e2798-9f5b-4937-bd57-c7e437869162
Heng, Daniel Y.C.
dd68fb74-d03b-48cc-bd13-43be2fbe4b88
Sridhar, Srikala
adde77d5-9697-42d0-b905-45fef386f204
Crabb, Simon J.
bcd1b566-7677-4f81-8429-3ab0e85f8373
Alimohamed, Nimira S.
34266043-ff00-48f8-8847-62398303b317

Kaiser, Jeenan, Li, Haocheng, North, Scott A., Leibowitz-Amit, Raya, Seah, Jo-An, Morshed, Nisha, Chau, Caroline, Lee-Ying, Richard, Heng, Daniel Y.C., Sridhar, Srikala, Crabb, Simon J. and Alimohamed, Nimira S. (2018) The prognostic role of the change in neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: A retrospective, multi-institutional sudy. Bladder cancer (Amsterdam, Netherlands), 4 (2), 185-194. (doi:10.3233/BLC-170133).

Record type: Article

Abstract

Background: The impact of the change in the neutrophil-to-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NAC) on outcomes in patients with muscle-invasive bladder cancer (MIBC) is poorly understood.

Objective: To evaluate the prognostic impact of the change in NLR during NAC for patients with MIBC.

Methods: Patients referred to academic, community, and quaternary referral centres in Alberta, Canada from 2005 to 2015, Ontario, Canada from 2005 to 2013, and Southampton, UK from 2004 to 2010 were evaluated. 376 eligible patients were treated with NAC for clinical T2-4aN0M0 disease, and 296 were evaluable for the change in NLR. A high NLR was defined as being an NLR > 3. Relationships between the change in NLR from baseline to mid-NAC (pre-cycle 3) and outcomes were analyzed using multivariable Cox regression. Kaplan-Meier analysis was used with the log-rank test for group comparisons.

Results: Median follow-up was 22.0 months (95% confidence interval [CI]: 14.9-30.0). Patients with a sustained high NLR had a median disease-free survival (DFS) of 12.6 months, compared to 34.8 months for those with a sustained low NLR (log-rank test p = 0.0025; hazard ratio [HR] 0.61 [95% CI: 0.44-0.84]). Median overall survival (OS) was 19.4 months for patients with a sustained high NLR, compared to 44.0 months for patients with a sustained low NLR (log-rank test p = 0.0011; HR 0.54 [95% CI: 0.38-0.77]).

Conclusions: A sustained high NLR from baseline to mid-NAC is an independent prognostic factor for patients with MIBC.

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e-pub ahead of print date: 26 April 2018
Keywords: Journal Article

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Local EPrints ID: 420929
URI: https://eprints.soton.ac.uk/id/eprint/420929
ISSN: 2352-3727
PURE UUID: cdf51c2e-9590-4f6a-80cc-65bf418fa9e2

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Date deposited: 18 May 2018 16:30
Last modified: 13 Mar 2019 18:29

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Contributors

Author: Jeenan Kaiser
Author: Haocheng Li
Author: Scott A. North
Author: Raya Leibowitz-Amit
Author: Jo-An Seah
Author: Nisha Morshed
Author: Caroline Chau
Author: Richard Lee-Ying
Author: Daniel Y.C. Heng
Author: Srikala Sridhar
Author: Simon J. Crabb
Author: Nimira S. Alimohamed

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