Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer

OBJECTIVE: To determine the role of neutrophil-to-lymphocyte ratio (NLR) in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer. METHODS: We retrospectively reviewed 84 patients undergoing radical cystectomy (RC) for UCB from January 2002 to June 2012. NLR was computed (median: 5 days) prior to surgery. No patients received neoadjuvant chemotherapy. NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained, with a statistical receiver operating characteristics of 0.74. Kaplan–Meier curves, multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes. RESULTS: The median follow-up period was 30.1 months (range: 3.2–161.7) owing to high recurrence rate and subsequent mortalities, compared to the median 64.7 months in patients alive at the end of study period. NLR ≥2.7 was associated with worse survival outcomes (5-year disease-specific survival: 22% vs 58%, p = 0.017, 95%CI: 1.193–6.009; 5-year overall survival: 23% vs 60%, p = 0.008, 95%CI: 1.322–6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate (p = 0.007, HR =6.999, 95%CI: 1.712–28.606), higher T staging (p = 0.021, HR = 3.479, 95%CI: 1.212–9.990) and lymph node involvement (p = 0.009, HR = 4.534, 95%CI: 1.465–14.034). CONCLUSION: This study suggests that NLR can be an inexpensive novel factor for patients risk stratification pre-operatively. This improves patient counseling and identifies patients who may benefit from multimodal treatment.