High postoperative neutrophil‑to‑lymphocyte ratio as a poor prognostic marker in patients with upper tract urothelial carcinoma

  • Authors:
    • Kiyoaki Nishihara
    • Shigetaka Suekane
    • Kousuke Ueda
    • Makoto Nakiri
    • Mitsunori Matsuo
    • Tsukasa Igawa
  • View Affiliations

  • Published online on: March 21, 2019     https://doi.org/10.3892/ol.2019.10178
  • Pages: 5241-5250
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

Previously, the preoperative neutrophil‑to‑lymphocyte ratio (NLR) has been demonstrated to be a beneficial prognostic marker in patients with upper tract urothelial carcinoma (UTUC). However, to the best of our knowledge, the postoperative NLR has rarely been investigated. Therefore, the present study evaluated the prognostic significance of postoperative NLR in patients with UTUC. Data of patients with UTUC who underwent surgical treatment at Kurume University hospital (Kurume, Japan) between 2004 and 2015 were retrospectively reviewed. Clinicopathological characteristics were analyzed, including pre‑ and postoperative NLRs. Overall survival (OS) and cancer‑specific survival (CSS) rates were estimated using the Kaplan‑Meier method and compared with a log‑rank test. Multivariate proportional Cox regression models were applied for both endpoints to identify the independent prognostic significance of NLR. The median age of the 134 enrolled patients was 70 years. The postoperative NLR was elevated in 35 patients (26.1%). A high postoperative NLR of ≥2.5 was significantly associated with a high postoperative C‑reactive protein level of ≥0.3 mg/dl, an advanced pathological T stage and positive lymphovascular invasion in surgical specimens (P<0.001, P=0.019 and P=0.024, respectively). The 5‑year OS rates in patients with high and low postoperative NLR were 33.7 and 70.2%, respectively (P<0.001), and the 5‑year CSS rates in patients with a high and low postoperative NLR were 33.7 and 80.7%, respectively (P<0.001). Multivariate analysis revealed that a high postoperative NLR was an independent prognostic marker for OS (hazard ratio, 4.66; 95% confidence interval, 2.11‑10.00; P<0.001) and CSS (hazard ratio, 10.90; 95% confidence interval, 4.32‑28.40; P<0.001), and the preoperative NLR was not identified as a prognostic marker. In conclusion, a high postoperative NLR is associated with a poor prognosis in patients with UTUC. Therefore, postoperative NLR may be a potential prognostic marker in patients with UTUC undergoing nephroureterectomy.

References

1 

Oya M and Kikuchi E; Committee for Establishment of Clinical Practice Guideline for Management of Upper Tract Urothelial Carcinoma; Japanese Urological Association, : Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary-Japanese Urological Association, 2014 edition). Int J Urol. 22:3–13. 2015. View Article : Google Scholar : PubMed/NCBI

2 

Siegel R, Naishadham D and Jemal A: Cancer statistics, 2012. CA Cancer J Clin. 62:10–29. 2012. View Article : Google Scholar : PubMed/NCBI

3 

Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Böhle A, Van Rhijn BWG, Kaasinen E, et al: European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol. 68:868–879. 2015. View Article : Google Scholar : PubMed/NCBI

4 

Ministry of Health, Labour and Welfare, . Vital Statistics of Japan (Volume 1~3), General Mortality. simplehttps://www.mhlw.go.jp/english/database/db-hw/vs01.htmlSeptember 7–2018

5 

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD and Wood CG: Upper tract urothelial carcinoma collaboration the upper tract urothelial carcinoma collaboration: outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration. Cancer. 115:1224–1233. 2009. View Article : Google Scholar : PubMed/NCBI

6 

Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG and Sherif A; European Association of Urology, : EAU guidelines on muscle-invasive and metastatic bladder cancer: Summary of the 2013 guidelines. Eur Urol. 65:778–792. 2014. View Article : Google Scholar : PubMed/NCBI

7 

Rink M, Sjoberg D, Comploj E, Margulis V, Xylinas E, Lee RK, Hansen J, Cha EK, Raman JD, Remzi M, et al: Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. Ann Surg Oncol. 19:4337–4344. 2012. View Article : Google Scholar : PubMed/NCBI

8 

Leow JJ, Orsola A, Chang SL and Bellmunt J: A contemporary review of management and prognostic factors of upper tract urothelial carcinoma. Cancer Treat Rev. 41:310–319. 2015. View Article : Google Scholar : PubMed/NCBI

9 

Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC and Clarke SJ: The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol. 88:218–230. 2013. View Article : Google Scholar : PubMed/NCBI

10 

Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, et al: Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis. J Natl Cancer Inst. 106:dju1242014. View Article : Google Scholar : PubMed/NCBI

11 

Viers BR, Boorjian SA, Frank I, Tarrell RF, Thapa P, Karnes RJ, Thompson RH and Tollefson MK: Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Eur Urol. 66:1157–1164. 2014. View Article : Google Scholar : PubMed/NCBI

12 

Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T and Tachibana M: Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 79:1085–1091. 2012. View Article : Google Scholar : PubMed/NCBI

13 

Krane LS, Richards KA, Kader AK, Davis R, Balaji KC and Hemal AK: Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy. J Endourol. 27:1046–1050. 2013. View Article : Google Scholar : PubMed/NCBI

14 

Tanaka N, Kikuchi E, Kanao K, Matsumoto K, Shirotake S, Miyazaki Y, Kobayashi H, Kaneko G, Hagiwara M, Ide H, et al: A multi-institutional validation of the prognostic value of the neutrophil-to-lymphocyte ratio for upper tract urothelial carcinoma treated with radical nephroureterectomy. Ann Surg Oncol. 21:4041–4048. 2014. View Article : Google Scholar : PubMed/NCBI

15 

Dalpiaz O, Ehrlich GC, Mannweiler S, Hernández JM, Gerger A, Stojakovic T, Pummer K, Zigeuner R, Pichler M and Hutterer GC: Validation of pretreatment neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma. BJU Int. 114:334–339. 2014.PubMed/NCBI

16 

Sobin LH, Gospodarowicz MK and Wittekind C: UICC TNM Classification of Malignant Tumours (7th edition). Wiley-Blackwell. New Jersey, NY: 2009.

17 

Mostofi FK, Davis CJ and Sesterhenn IA: World Health Organization International Histological Classification of Tumours. Histological typing of urinary bladder tumours (2nd edition). Springer-Verlag Berlin. Heidelberg: 1999. View Article : Google Scholar

18 

Azuma T, Matayoshi Y, Odani K, Sato Y, Sato Y, Nagase Y and Oshi M: Preoperative neutrophil-lymphocyte ratio as an independent prognostic marker for patients with upper urinary tract urothelial carcinoma. Clin Genitourin Cancer. 11:337–341. 2013. View Article : Google Scholar : PubMed/NCBI

19 

Advanced Bladder Cancer (ABC) Meta-analysis Collaboration, . Neoadjuvant chemotherapy in invasive bladder cancer: Update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 48:202–205; discussion 205–206. 2005. View Article : Google Scholar : PubMed/NCBI

20 

Fritz GA, Schoellnast H, Deutschmann HA, Quehenberger F and Tillich M: Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol. 16:1244–1252. 2006. View Article : Google Scholar : PubMed/NCBI

21 

Kang M, Jeong CW, Kwak C, Kim HH and Ku JH: The prognostic significance of the early postoperative neutrophil-to-lymphocyte ratio in patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Ann Surg Oncol. 23:335–342. 2016. View Article : Google Scholar : PubMed/NCBI

22 

Morizawa Y, Miyake M, Shimada K, Hori S, Tatsumi Y, Nakai Y, Anai S, Tanaka N, Konishi N and Fujimoto K: Neutrophil-to-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy. Urol Oncol. 34(257): e211–257. 2016.doi.org/10.1016/j.urolonc.2016.02.012.

23 

Tanaka H, Tamura T, Toyokawa T, Muguruma K, Miki Y, Kubo N, Sakurai K, Hirakawa K and Ohira M: Clinical relevance of postoperative neutrophil-lymphocyte ratio (NLR) to recurrence after adjuvant chemotherapy of S-1 for gastric cancer. Anticancer Res. 38:3745–3751. 2018. View Article : Google Scholar : PubMed/NCBI

24 

Jin F, Han A, Shi F, Kong L and Yu J: The postoperative neutrophil-to-lymphocyte ratio and changes in this ratio predict survival after the complete resection of stage I non-small cell lung cancer. OncoTargets Ther. 9:6529–6537. 2016. View Article : Google Scholar

25 

Birtle AJ, Chester JD, Jones RJ, Johnson M, Hill M, Bryan RT, Catto J, Donovan J, French A, Harris C, et al: Results of POUT: A phase III randomised trial of perioperative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC). J Clin Oncol. 36 (6_suppl):407. 2018. View Article : Google Scholar

26 

Mantovani A, Allavena P, Sica A and Balkwill F: Cancer-related inflammation. Nature. 454:436–444. 2008. View Article : Google Scholar : PubMed/NCBI

27 

Balkwill F and Mantovani A: Inflammation and cancer: Back to Virchow? Lancet. 357:539–545. 2001. View Article : Google Scholar : PubMed/NCBI

28 

Gooden MJ, de Bock GH, Leffers N, Daemen T and Nijman HW: The prognostic influence of tumour-infiltrating lymphocytes in cancer: A systematic review with meta-analysis. Br J Cancer. 105:93–103. 2011. View Article : Google Scholar : PubMed/NCBI

29 

Fogar P, Sperti C, Basso D, Sanzari MC, Greco E, Davoli C, Navaglia F, Zambon CF, Pasquali C, Venza E, et al: Decreased total lymphocyte counts in pancreatic cancer: An index of adverse outcome. Pancreas. 32:22–28. 2006. View Article : Google Scholar : PubMed/NCBI

30 

Saroha S, Uzzo RG, Plimack ER, Ruth K and Al-Saleem T: Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma. J Urol. 189:454–461. 2013. View Article : Google Scholar : PubMed/NCBI

31 

Glaser R and Kiecolt-Glaser JK: Stress-induced immune dysfunction: Implications for health. Nat Rev Immunol. 5:243–251. 2005. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

June 2019
Volume 17 Issue 6

Print ISSN: 1792-1074
Online ISSN:1792-1082

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
APA
Nishihara, K., Suekane, S., Ueda, K., Nakiri, M., Matsuo, M., & Igawa, T. (2019). High postoperative neutrophil‑to‑lymphocyte ratio as a poor prognostic marker in patients with upper tract urothelial carcinoma. Oncology Letters, 17, 5241-5250. https://doi.org/10.3892/ol.2019.10178
MLA
Nishihara, K., Suekane, S., Ueda, K., Nakiri, M., Matsuo, M., Igawa, T."High postoperative neutrophil‑to‑lymphocyte ratio as a poor prognostic marker in patients with upper tract urothelial carcinoma". Oncology Letters 17.6 (2019): 5241-5250.
Chicago
Nishihara, K., Suekane, S., Ueda, K., Nakiri, M., Matsuo, M., Igawa, T."High postoperative neutrophil‑to‑lymphocyte ratio as a poor prognostic marker in patients with upper tract urothelial carcinoma". Oncology Letters 17, no. 6 (2019): 5241-5250. https://doi.org/10.3892/ol.2019.10178