Prognostic Role of Neutrophil-to-lymphocyte Ratio-based Markers During Pre- and Postadjuvant Chemotherapy in Patients With Advanced Urothelial Carcinoma of Upper Urinary Tract

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PurposeThe aim of the present study was to assess the prognostic significance of neutrophil-to-lymphocyte ratio (NLR)-based markers before and after adjuvant chemotherapy (ACH) in patients with urothelial carcinoma of the upper urinary tract (UTUC) undergoing radical nephroureterectomy (RNU) and ACH.Materials and MethodsThe data from 112 patients with advanced UTUC who had undergone first-line ACH after RNU from 1994 to 2012 were reviewed. After excluding 22 patients, the clinicopathologic data for 90 patients were analyzed, in particular, the NLR and derived NLR (dNLR) preoperatively and before and after ACH. Cancer-specific survival (CSS) and overall survival (OS) outcomes were measured using Kaplan-Meier analysis. To identify the predictors for the oncologic outcomes, a multivariate Cox regression model was used.ResultsPatients with a higher preoperative NLR, pre-ACH dNLR, and post-ACH dNLR had poorer CSS and OS than their counterparts with lower values. After adjustment of various clinicopathologic factors, age at surgery (≥ 65 years; hazard ratio [HR], 3.13) and higher post-ACH dNLR (HR, 3.06) remained significant predictors for CSS. Similarly, age (≥ 65 years; HR, 2.90) and elevated post-ACH dNLR (≥ 2.3; HR, 2.89) were also identified as predictors of OS on multivariate analysis.ConclusionA higher post-ACH dNLR was independently predictive of poor CSS and OS in patients with advanced UTUC receiving systemic ACH after RNU. From the obtained data, we propose that the NLR-based marker could be a readily available and valuable biomarker for predicting oncologic outcomes after chemotherapy.Micro-AbstractDespite the prognostic significance of neutrophil-to-lymphocyte ratio (NLR)-based markers, such as the NLR and derived NLR, in patients with various malignancies receiving systemic chemotherapy, no reports have been published on the prognostic role of these markers in late-stage urothelial carcinoma of the upper urinary tract treated with adjuvant chemotherapy. We found that a higher derived NLR after adjuvant chemotherapy was independently predictive of poor survival outcomes in patients with advanced urothelial carcinoma of the upper urinary tract receiving systemic adjuvant chemotherapy after radical nephroureterectomy.

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