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Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy
OBJECTIVE: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-in...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233730/ https://www.ncbi.nlm.nih.gov/pubmed/27209168 http://dx.doi.org/10.1007/s00345-016-1848-9 |
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author | Vartolomei, Mihai Dorin Mathieu, Romain Margulis, Vitaly Karam, Jose A. Rouprêt, Morgan Lucca, Ilaria Mbeutcha, Aurélie Seitz, Christian Karakiewicz, Pierre I. Fajkovic, Harun Wood, Christopher G. Weizer, Alon Z. Raman, Jay D. Rioux-Leclercq, Nathalie Haitel, Andrea Bensalah, Karim Rink, Michael Briganti, Alberto Xylinas, Evanguelos Shariat, Shahrokh F. |
author_facet | Vartolomei, Mihai Dorin Mathieu, Romain Margulis, Vitaly Karam, Jose A. Rouprêt, Morgan Lucca, Ilaria Mbeutcha, Aurélie Seitz, Christian Karakiewicz, Pierre I. Fajkovic, Harun Wood, Christopher G. Weizer, Alon Z. Raman, Jay D. Rioux-Leclercq, Nathalie Haitel, Andrea Bensalah, Karim Rink, Michael Briganti, Alberto Xylinas, Evanguelos Shariat, Shahrokh F. |
author_sort | Vartolomei, Mihai Dorin |
collection | PubMed |
description | OBJECTIVE: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort. METHODS: Preoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models. RESULTS: Altered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03). CONCLUSION: In UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy. |
format | Online Article Text |
id | pubmed-5233730 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-52337302017-01-25 Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy Vartolomei, Mihai Dorin Mathieu, Romain Margulis, Vitaly Karam, Jose A. Rouprêt, Morgan Lucca, Ilaria Mbeutcha, Aurélie Seitz, Christian Karakiewicz, Pierre I. Fajkovic, Harun Wood, Christopher G. Weizer, Alon Z. Raman, Jay D. Rioux-Leclercq, Nathalie Haitel, Andrea Bensalah, Karim Rink, Michael Briganti, Alberto Xylinas, Evanguelos Shariat, Shahrokh F. World J Urol Original Article OBJECTIVE: Several retrospective studies with small cohorts reported neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). We aimed at validating the predictive and prognostic role of NLR in a large multi-institutional cohort. METHODS: Preoperative NLR was assessed in a multi-institutional cohort of 2477 patients with UTUC treated with RNU. Altered NLR was defined by a ratio >2.7. Logistic regression analyses were performed to assess the association between NLR and lymph node metastasis, muscle-invasive and non-organ-confined disease. The association of altered NLR with recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Cox proportional hazards regression models. RESULTS: Altered NLR was observed in 1428 (62.8 %) patients and associated with more advanced pathological tumor stage, lymph node metastasis, lymphovascular invasion, tumor necrosis and sessile tumor architecture. In a preoperative model that included age, gender, tumor location and architecture, NLR was an independent predictive factor for the presence of lymph node metastasis, muscle-invasive and non-organ-confined disease (p < 0.001). Within a median follow-up of 40 months (IQR 20–76 months), 548 (24.1 %) patients experienced disease recurrence and 453 patients (19.9 %) died from their cancer. Compared to patients with normal NLR, those with altered NLR had worse RFS (0.003) and CSS (p = 0.002). In multivariable analyses that adjusted for the effects of standard clinicopathologic features, altered NLR did not retain an independent value. In the subgroup of patients treated with lymphadenectomy in addition to RNU, NLR was independently associated with CSS (p = 0.03). CONCLUSION: In UTUC, preoperative NLR is associated with adverse clinicopathologic features and independently predicts features of biologically and clinically aggressive UTUC such as lymph node metastasis, muscle-invasive or non-organ-confined status. NLR may help better risk stratify patients with regard to lymphadenectomy and conservative therapy. Springer Berlin Heidelberg 2016-05-21 2017 /pmc/articles/PMC5233730/ /pubmed/27209168 http://dx.doi.org/10.1007/s00345-016-1848-9 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Vartolomei, Mihai Dorin Mathieu, Romain Margulis, Vitaly Karam, Jose A. Rouprêt, Morgan Lucca, Ilaria Mbeutcha, Aurélie Seitz, Christian Karakiewicz, Pierre I. Fajkovic, Harun Wood, Christopher G. Weizer, Alon Z. Raman, Jay D. Rioux-Leclercq, Nathalie Haitel, Andrea Bensalah, Karim Rink, Michael Briganti, Alberto Xylinas, Evanguelos Shariat, Shahrokh F. Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title | Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title_full | Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title_fullStr | Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title_full_unstemmed | Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title_short | Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
title_sort | promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233730/ https://www.ncbi.nlm.nih.gov/pubmed/27209168 http://dx.doi.org/10.1007/s00345-016-1848-9 |
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