Elevated Baseline Neutrophil Count Correlates with Worse Outcomes in Patients with Muscle-Invasive Bladder Cancer Treated with Chemoradiation

SIMPLE SUMMARY: Inflammation plays a role in the development and prognosis of bladder cancer. We aimed at studying the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and neutrophil count (PNN) at baseline in patients with localized bladder cancer treated with chemoradiation. High NLR > 2.6 was associated with shorter overall survival (OS) in univariate analysis only, whereas high PNN > 4000/mm(3) was associated with shorter OS and progression-free survival in univariate and multivariate analyses. Along with other established prognostic factors, baseline PNN could serve as a biomarker to incorporate in a novel nomogram for selecting patients who might benefit from a bladder preservation strategy. ABSTRACT: Background: The role of inflammation in the development and prognosis of bladder cancer (BC) is now established. We evaluated the significance of neutrophil-to-lymphocyte ratio (NLR) and neutrophil count (PNN) in patients with localized BC treated with chemoradiation. Methods: Clinical characteristics and baseline biological data were retrospectively collected. We tested the association between NLR, PNN, and overall survival (OS) and progression-free survival (PFS). Results: One hundred and ninety-four patients were included. Median PNN was 4000.0/mm(3) [1500.0–16,858.0] and median NLR was 2.6 [0.6–19.2]. In patients with NLR > 2.6, median OS and PFS were lower (OS: 25.5 vs. 58.4 months, p = 0.02; PFS: 14.1 vs. 26.7 months, p = 0.07). Patients with PNN > 4000/mm(3) had significantly lower OS (21.8 vs. 70.1 months, p < 0.001) and PFS (13.7 vs. 38.8 months, p < 0.001). Contrary to NLR, PNN > 4000/mm(3) was associated with shorter OS and PFS in multivariate analysis. Conclusions: Elevated PNN at baseline was associated with worse OS and PFS. NLR was not an independent prognostic factor.