TY - JOUR
T1 - Prognostic significance of markers of systemic inflammatory response in patients with non–muscle-invasive bladder cancer
AU - Mbeutcha, Aurélie
AU - Shariat, Shahrokh F.
AU - Rieken, Malte
AU - Rink, Michael
AU - Xylinas, Evanguelos
AU - Seitz, Christian
AU - Lucca, Ilaria
AU - Mathieu, Romain
AU - Rouprêt, Morgan
AU - Briganti, Alberto
AU - Karakiewicz, Pierre I.
AU - Klatte, Tobias
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non–muscle-invasive bladder cancer (NMIBC) have not been well studied yet. Patients and methods We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months. Results In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5 mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%). Conclusion In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.
AB - Background The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non–muscle-invasive bladder cancer (NMIBC) have not been well studied yet. Patients and methods We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months. Results In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5 mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%). Conclusion In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.
KW - BCG
KW - Biomarker
KW - Guideline
KW - Prediction
KW - Prognosis
KW - Progression
KW - Response
UR - http://www.scopus.com/inward/record.url?scp=84994164662&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994164662&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2016.05.013
DO - 10.1016/j.urolonc.2016.05.013
M3 - Article
AN - SCOPUS:84994164662
VL - 34
SP - 483.e17-483.e24
JO - Urologic Oncology
JF - Urologic Oncology
SN - 1078-1439
IS - 11
ER -