Predictive and Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Muscle Invasive Bladder Cancer Treated With Neoadjuvant Chemotherapy and Radical Cystectomy
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Predictive and Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Muscle Invasive Bladder Cancer Treated With Neoadjuvant Chemotherapy and Radical Cystectomy. / von Deimling, Markus; Schuettfort, Victor M; D'Andrea, David; Pradere, Benjamin; Grossmann, Nico C; Kawada, Tatsushi; Yanagisawa, Takafumi; Majdoub, Muhammad; Laukhtina, Ekaterina; Rajwa, Pawel; Quhal, Fahad; Mostafaei, Hadi; Fajkovic, Harun; Teoh, Jeremy Yuen-Chun; Moschini, Marco; Karakiewicz, Pierre I; Fisch, Margit; Rink, Michael; Shariat, Shahrokh F.
in: CLIN GENITOURIN CANC, Jahrgang 21, Nr. 4, 08.2023, S. 430-441.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Predictive and Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Muscle Invasive Bladder Cancer Treated With Neoadjuvant Chemotherapy and Radical Cystectomy
AU - von Deimling, Markus
AU - Schuettfort, Victor M
AU - D'Andrea, David
AU - Pradere, Benjamin
AU - Grossmann, Nico C
AU - Kawada, Tatsushi
AU - Yanagisawa, Takafumi
AU - Majdoub, Muhammad
AU - Laukhtina, Ekaterina
AU - Rajwa, Pawel
AU - Quhal, Fahad
AU - Mostafaei, Hadi
AU - Fajkovic, Harun
AU - Teoh, Jeremy Yuen-Chun
AU - Moschini, Marco
AU - Karakiewicz, Pierre I
AU - Fisch, Margit
AU - Rink, Michael
AU - Shariat, Shahrokh F
N1 - Copyright © 2023 Elsevier Inc. All rights reserved.
PY - 2023/8
Y1 - 2023/8
N2 - INTRODUCTION: There is a persistent lack of validated biomarkers that identify patients most likely to benefit from neoadjuvant chemotherapy (NAC) in urothelial carcinoma of the bladder (UCB). Therefore, the purpose of this study was to investigate the predictive and prognostic impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in UCB patients treated with NAC and radical cystectomy (RC).PATIENTS AND METHODS: We conducted a retrospective analysis of an international-multicenter database comprising 404 UCB patients staged cT2-4N0-3M0. The cohort was split into low and high NLR using an optimal cutoff value determined by maximizing Youden's index. Logistic and Cox regression analyses were performed with respect to several clinical endpoints. The discriminative ability of the models and the additive discriminative value of NLR was assessed by calculating the area under receiver operating characteristics curves, C-index, and decision curve analysis (DCA).RESULTS: A total of 169 patients (41.8%) had a high NLR, which was associated with a decreased probability of complete response (CR, OR: 0.24 [95% CI, 0.13-0.42], P < .001) and/or partial response (PR, OR: 0.33 [95% CI, 0.21-0.49], P < .001). Adding the NLR to predictive reference models significantly improved their accuracy for the prediction of both CR and PR. A high NLR was associated with poor survival outcomes in the pretreatment setting, however, it didn't meaningfully change the C-index based on the model.CONCLUSION: We confirmed that an elevated NLR is an independent and clinically significant predictor of response to NAC and adverse pathological features in UCB treated with NAC plus RC. The accuracy of this biomarker in the age of immunotherapy warrants further evaluation.
AB - INTRODUCTION: There is a persistent lack of validated biomarkers that identify patients most likely to benefit from neoadjuvant chemotherapy (NAC) in urothelial carcinoma of the bladder (UCB). Therefore, the purpose of this study was to investigate the predictive and prognostic impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in UCB patients treated with NAC and radical cystectomy (RC).PATIENTS AND METHODS: We conducted a retrospective analysis of an international-multicenter database comprising 404 UCB patients staged cT2-4N0-3M0. The cohort was split into low and high NLR using an optimal cutoff value determined by maximizing Youden's index. Logistic and Cox regression analyses were performed with respect to several clinical endpoints. The discriminative ability of the models and the additive discriminative value of NLR was assessed by calculating the area under receiver operating characteristics curves, C-index, and decision curve analysis (DCA).RESULTS: A total of 169 patients (41.8%) had a high NLR, which was associated with a decreased probability of complete response (CR, OR: 0.24 [95% CI, 0.13-0.42], P < .001) and/or partial response (PR, OR: 0.33 [95% CI, 0.21-0.49], P < .001). Adding the NLR to predictive reference models significantly improved their accuracy for the prediction of both CR and PR. A high NLR was associated with poor survival outcomes in the pretreatment setting, however, it didn't meaningfully change the C-index based on the model.CONCLUSION: We confirmed that an elevated NLR is an independent and clinically significant predictor of response to NAC and adverse pathological features in UCB treated with NAC plus RC. The accuracy of this biomarker in the age of immunotherapy warrants further evaluation.
KW - Humans
KW - Urinary Bladder Neoplasms/drug therapy
KW - Carcinoma, Transitional Cell/drug therapy
KW - Prognosis
KW - Urinary Bladder/pathology
KW - Cystectomy
KW - Retrospective Studies
KW - Neoadjuvant Therapy
KW - Neutrophils/pathology
KW - Lymphocytes/pathology
KW - Biomarkers
KW - Muscles/pathology
U2 - 10.1016/j.clgc.2023.01.008
DO - 10.1016/j.clgc.2023.01.008
M3 - SCORING: Journal article
C2 - 36781346
VL - 21
SP - 430
EP - 441
JO - CLIN GENITOURIN CANC
JF - CLIN GENITOURIN CANC
SN - 1558-7673
IS - 4
ER -
