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

Research output: Contribution to journalArticle

45 Citations (Scopus)

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

ASJC Scopus subject areas

  • Surgery
  • Oncology

Fingerprint Dive into the research topics of 'A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy'. Together they form a unique fingerprint.

  • Cite this

    Tanaka, N., Kikuchi, E., Kanao, K., Matsumoto, K., Shirotake, S., Miyazaki, Y., Kobayashi, H., Kaneko, G., Hagiwara, M., Ide, H., Obata, J., Hoshino, K., Hayakawa, N., Kosaka, T., Hara, S., Oyama, M., Momma, T., Nakajima, Y., Jinzaki, M., & Oya, M. (2014). A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. Annals of Surgical Oncology, 21(12), 4041-4048. https://doi.org/10.1245/s10434-014-3830-3