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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
M. von Deimling, VM. Schuettfort, D. D'Andrea, B. Pradere, NC. Grossmann, T. Kawada, T. Yanagisawa, M. Majdoub, E. Laukhtina, P. Rajwa, F. Quhal, H. Mostafaei, H. Fajkovic, JY. Teoh, M. Moschini, PI. Karakiewicz, M. Fisch, M. Rink, SF. Shariat
Language English Country United States
Document type Multicenter Study, Journal Article
- MeSH
- Biomarkers MeSH
- Cystectomy MeSH
- Carcinoma, Transitional Cell * drug therapy surgery MeSH
- Humans MeSH
- Lymphocytes pathology MeSH
- Urinary Bladder pathology MeSH
- Urinary Bladder Neoplasms * drug therapy surgery MeSH
- Neoadjuvant Therapy MeSH
- Neutrophils pathology MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Muscles pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
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.
Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Hillel Yaffe Medical Center Hadera Israel
Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia
Department of Urology La Croix Du Sud Hospital Quint Fonsegrives France
Department of Urology Luzerner Kantonsspital Luzern Switzerland
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas TX
Department of Urology Urological Research Institute San Raffaele Scientific Institute Milan Italy
Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
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- $a von Deimling, Markus $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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- $a Predictive and Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Muscle Invasive Bladder Cancer Treated With Neoadjuvant Chemotherapy and Radical Cystectomy / $c M. von Deimling, VM. Schuettfort, D. D'Andrea, B. Pradere, NC. Grossmann, T. Kawada, T. Yanagisawa, M. Majdoub, E. Laukhtina, P. Rajwa, F. Quhal, H. Mostafaei, H. Fajkovic, JY. Teoh, M. Moschini, PI. Karakiewicz, M. Fisch, M. Rink, SF. Shariat
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- $a 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.
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