Validation of Neutrophil-to-lymphocyte Ratio in a Multi-institutional Cohort of Patients With T1G3 Non-muscle-invasive Bladder Cancer

Mihai Dorin Vartolomei, Matteo Ferro, Francesco Cantiello, Giuseppe Lucarelli, Savino Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Ettore De Berardinis, Rocco Damiano, Sisto Perdona, Paolo Verze, Roberto La Rocca, Marco Borghesi, Riccardo Schiavina, Eugenio Brunocilla, Gilberto L Almeida, Pierluigi Bove, Estevao Lima, Giovanni GrimaldiRiccardo Autorino, Nicolae Crisan, Abdal Rahman Abu Farhan, Michele Battaglia, Vincenzo Serretta, Giorgio Ivan Russo, Giuseppe Morgia, Daniela Terracciano, Gennaro Musi, Ottavio de Cobelli, Vincenzo Mirone, Shahrokh F Shariat

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND METHODS: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS).

RESULTS: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%).

CONCLUSIONS: Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up.

Original languageEnglish
Pages (from-to)445-452
Number of pages8
JournalClinical Genitourinary Cancer
Issue number6
Publication statusPublished - Dec 2018


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