Preoperative neutrophil to lymphocyte ratio improves recurrence prediction of non-muscle invasive bladder cancer

BackgroundThis study aims to prospectively evaluate the ability of Neutrophil-to-Lymphocyte ratio (NLR) to forecast recurrence in patients with non-muscle invasive bladder cancer (NMIBC). This is a continuation of our two previous retrospective studies that indicated the NLR>2.5 criterion as a predictor of recurrence in patients with NMIBC.MethodsSince December 2013, all patients admitted to our department for TUR-BT and agreed to participate, had a blood drawn for cell count and differential 24h prior to surgery. Patients with pathological NMIBC were followed prospectively for disease recurrence. The end-point of the follow up was either a cancer recurrence or the termination of the study. Univariate and multivariate Cox regressions were performed to assess the NLR>2.5 predictive capability for recurrence, versus and in conjunction to the pathologically based EORTC score, among additional statistical analyses.ResultsThe study cohort included 96 men and 17 women with a median age of 72years. Sixty-four patients (56.6%) have had a recurrence during the study occurring at the median time of 9months (IQR 6, 13), while the median follow-up time for patients without recurrence was 18months (IQR 10, 29). Univariate Cox regressions for recurrence demonstrated significance for NLR>2.5 for the whole cohort (p=0.011, HR 2.015, CI 1.175-3.454) and for the BCG sub-group (p=0.023, HR 3.7, CI 1.2-11.9), while the EORTC score demonstrated significance for the No Treatment' subgroup (p=0.024, HR 1.278, CI 1.03-1.58). When analyzed together as a multivariate Cox model, the NLR>2.5 and EORTC score retained their significance for the aforementioned groups, while also improving the EORTC score significance for the whole cohort.ConclusionNLR>2.5 was found to be a significant predictor of disease recurrence and demonstrated high hazard ratio and worse recurrence-free survival in patients with NMIBC, especially in those treated with BCG. Additionally, our data demonstrated statistical evidence that NLR>2.5 might have an improving effect on the EORTC score's prediction when analyzed together.