Validation of neutrophil-to-lymphocyte ratio in a multi-institutional cohort of patients with T1G3 non–muscle-invasive bladder cancer
Neutrophil-to-lymphocyte ratio was found associated with worse disease recurrence and progression in patients with T1 non–muscle-invasive bladder cancer in some single-center studies. We validated high pretreatment neutrophil-to-lymphocyte ratio (cutoff, 3) as an independent predictor of disease recurrence, progression, and cancer-specific survival in patients with primary T1 HG/G3 non–muscle-invasive bladder cancer treated with intravesical bacillus Calmette-Guérin therapy. Introduction: The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non–muscle-invasive bladder cancer (NMIBC). Patients and Methods: The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS). Results: A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR