TY - JOUR
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
N1 - Funding Information:
ACKNOWLEDGMENT Members of the Keio Collaboration Study of Urothelial Carcinoma participated in this study: Keishiro Fukumoto, Keio University School of Medicine, Tokyo, Japan; So Nakamura, Saiseikai Central Hospital, Tokyo, Japan; Takeshi Ma-suda, Saitama Municipal Hospital, Saitama, Japan; Shintaro Hasegawa, National Hospital Organization Tochigi Hospital, Tochigi, Japan; Atsushi Uchida, Kyosai Tachikawa Hospital, Tokyo, Japan; Kazuhiko Nagakura, Musashino Yowakai Hospital, Tokyo, Japan; Masakazu Ohashi, Ogikubo Hospital, Tokyo, Japan; Shoji Matsuzaki, Inagi Municipal Hospital, Tokyo, Japan; Kazutoyo Miyata, Irumag-awa Hospital, Saitama, Japan. This work was supported in part by Grants-in-Aid for Scientific Research (#26462429 to Nobuyuki Ta-naka) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.
Publisher Copyright:
© 2014, Society of Surgical Oncology.
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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U2 - 10.1245/s10434-014-3830-3
DO - 10.1245/s10434-014-3830-3
M3 - Article
C2 - 24912614
AN - SCOPUS:84918786598
SN - 1068-9265
VL - 21
SP - 4041
EP - 4048
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 12
ER -
