A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

Nobuyuki Tanaka, Eiji Kikuchi, Kent Kanao, Kazuhiro Matsumoto, Suguru Shirotake, Yasumasa Miyazaki, Hiroaki Kobayashi, Gou Kaneko, Masayuki Hagiwara, Hiroki Ide, Jun Obata, Katsura Hoshino, Nozomi Hayakawa, Takeo Kosaka, Satoshi Hara, Masafumi Oyama, Tetsuo Momma, Yosuke Nakajima, Masahiro Jinzaki, Mototsugu Oya

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Abstract

Background: To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).

Methods: A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.

Results: Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (p < 0.001) and 60.2 % (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (p = 0.041) and 83.0 % (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).

Conclusion: This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.

Original languageEnglish
Pages (from-to)4041-4048
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number12
DOIs
Publication statusPublished - 2014 Oct 8

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Neutrophils
Lymphocytes
Carcinoma
Recurrence
Neoplasms
Mortality
Multivariate Analysis
Lymph Nodes
Survival Rate

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. / Tanaka, Nobuyuki; Kikuchi, Eiji; Kanao, Kent; Matsumoto, Kazuhiro; Shirotake, Suguru; Miyazaki, Yasumasa; Kobayashi, Hiroaki; Kaneko, Gou; Hagiwara, Masayuki; Ide, Hiroki; Obata, Jun; Hoshino, Katsura; Hayakawa, Nozomi; Kosaka, Takeo; Hara, Satoshi; Oyama, Masafumi; Momma, Tetsuo; Nakajima, Yosuke; Jinzaki, Masahiro; Oya, Mototsugu.

In: Annals of Surgical Oncology, Vol. 21, No. 12, 08.10.2014, p. 4041-4048.

Research output: Contribution to journalArticle

Tanaka, Nobuyuki ; Kikuchi, Eiji ; Kanao, Kent ; Matsumoto, Kazuhiro ; Shirotake, Suguru ; Miyazaki, Yasumasa ; Kobayashi, Hiroaki ; Kaneko, Gou ; Hagiwara, Masayuki ; Ide, Hiroki ; Obata, Jun ; Hoshino, Katsura ; Hayakawa, Nozomi ; Kosaka, Takeo ; Hara, Satoshi ; Oyama, Masafumi ; Momma, Tetsuo ; Nakajima, Yosuke ; Jinzaki, Masahiro ; Oya, Mototsugu. / A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 12. pp. 4041-4048.
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title = "A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy",
abstract = "Background: To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).Methods: A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.Results: Pre-NLR levels were elevated in 184 patients (27.7 {\%}), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 {\%} (p < 0.001) and 60.2 {\%} (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 {\%}, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 {\%} (p = 0.041) and 83.0 {\%} (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 {\%}, respectively).Conclusion: This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.",
author = "Nobuyuki Tanaka and Eiji Kikuchi and Kent Kanao and Kazuhiro Matsumoto and Suguru Shirotake and Yasumasa Miyazaki and Hiroaki Kobayashi and Gou Kaneko and Masayuki Hagiwara and Hiroki Ide and Jun Obata and Katsura Hoshino and Nozomi Hayakawa and Takeo Kosaka and Satoshi Hara and Masafumi Oyama and Tetsuo Momma and Yosuke Nakajima and Masahiro Jinzaki and Mototsugu Oya",
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T1 - A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

AU - Tanaka, Nobuyuki

AU - Kikuchi, Eiji

AU - Kanao, Kent

AU - Matsumoto, Kazuhiro

AU - Shirotake, Suguru

AU - Miyazaki, Yasumasa

AU - Kobayashi, Hiroaki

AU - Kaneko, Gou

AU - Hagiwara, Masayuki

AU - Ide, Hiroki

AU - Obata, Jun

AU - Hoshino, Katsura

AU - Hayakawa, Nozomi

AU - Kosaka, Takeo

AU - Hara, Satoshi

AU - Oyama, Masafumi

AU - Momma, Tetsuo

AU - Nakajima, Yosuke

AU - Jinzaki, Masahiro

AU - Oya, Mototsugu

PY - 2014/10/8

Y1 - 2014/10/8

N2 - Background: To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).Methods: A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.Results: Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (p < 0.001) and 60.2 % (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (p = 0.041) and 83.0 % (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).Conclusion: This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.

AB - Background: To externally validate the prognostic impact of preoperative neutrophil–lymphocyte ratio (pre-NLR) in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).Methods: A total of 665 patients from 12 institutions were included. The median follow-up was 28 months. Associations between pre-NLR level and outcome were assessed using multivariate analysis. A pre-NLR level of >3.0 was defined as elevated.Results: Pre-NLR levels were elevated in 184 patients (27.7 %), and pre-NLR elevation was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive lymphovascular invasion (LVI), and lymph node involvement in RNU specimens. The 5-year recurrence-free and cancer-specific survival rates were 57.0 % (p < 0.001) and 60.2 % (p < 0.001), respectively, in patients with elevated pre-NLR, and 69.2 and 77.3 %, respectively, in their counterparts. Multivariate analysis showed that elevated pre-NLR was an independent risk factor for predicting subsequent disease recurrence (p = 0.037; hazard ratio (HR) 1.38) and cancer-specific mortality (p = 0.036;, HR 1.47), although the addition of pre-NLR slightly improved the accuracies of the base model for predicting both disease recurrence and cancer-specific mortality to 79.8 % (p = 0.041) and 83.0 % (p = 0.039), respectively (gain in predictive accuracy: 0.2 and 0.1 %, respectively).Conclusion: This multi-institutional study revealed that elevated pre-NLR was significantly associated with worse pathological features such as tumor grade 3, advanced pT stage, positive LVI, and lymph node involvement in RNU specimens, and elevated pre-NLR was an independent risk factor of disease recurrence and cancer-specific mortality in UTUC patients treated with RNU.

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