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% 58%,  = 0.017, 95%CI: 1.193-6.009; 5-year overall survival: 23% 60%,  = 0.008, 95%CI: 1.322-6.147). Furthermore, on multivariate analyses, higher NLR was independently associated with higher recurrence rate ( = 0.007, HR =6.999, 95%CI: 1.712-28.606), higher T staging ( = 0.021, HR = 3.479, 95%CI: 1.212-9.990) and lymph node involvement ( = 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.