Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non muscle invasive bladder cancer
BackgroundThis study aims to prospectively evaluate the ability of Neutrophil to Lymphocyte ratio (NLR) to forecast recurrence in patients with non muscle invasive bladder cancer (NMIBC) This is a continuation of our two previous retrospective studies that indicated the NLR 2.5 criterion as a predictor of recurrence in patients with NMIBC.MethodsSince December 2013, all patients admitted to our department for TUR BT and agreed to participate, had a blood drawn for cell count and differential 24 h prior to surgery. Patients with pathological NMIBC were followed prospectively for disease recurrence. The end point of the follow up was either a cancer recurrence or the termination of the study. Univariate and multivariate Cox regressions were performed to assess the NLR 2.5 predictive capability for recurrence, versus and in conjunction to the pathologically based EORTC score, among additional statistical analyses.ResultsThe study cohort included 96 men and 17 women with a median age of 72 years. Sixty four patients (56.6% have had a recurrence during the study occurring at the median time of 9 months (IQR 6, 13) while the median follow up time for patients without recurrence was 18 months (IQR 10, 29) Univariate Cox regressions for recurrence demonstrated significance for NLR 2.5 for the whole cohort (p 0.011, HR 2.015, CI 1.175 3.454) and for the BCG sub group (p 0.023, HR 3.7, CI 1.2 11.9) while the EORTC score demonstrated significance for the 'No Treatment' subgroup (p 0.024, HR 1.278, CI 1.03 1.58) When analyzed together as a multivariate Cox model, the NLR 2.5 and EORTC score retained their significance for the aforementioned groups, while also improving the EORTC score significance for the whole cohort.ConclusionNLR 2.5 was found to be a significant predictor of disease recurrence and demonstrated high hazard ratio and worse recurrence free survival in patients with NMIBC, especially in those treated with BCG. Additionally, our data demonstrated statistical evidence that NLR 2.5 might have an improving effect on the EORTC score's prediction when analyzed together.
BMC Urology