Presentation Authors: Kyeong-Hyeon Byeon, Heon Ha*, Jae-Wook Chung, Yun-Sok Ha, Seock Hwan Choi, Jun Nyung Lee, Bum Soo Kim, Hyun Tae Kim, Tae-Hwan Kim, Eun Sang Yoo, Tae Gyun Kwon, Sung Kwang Chung, Daugu, Korea, Republic of
Introduction: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammatory response, which has been associated with the tumor recurrence and progression. The purpose of this study is to assess the role of pretreatment NLR as a predictor of clinical outcomes in patients with non-muscle invasive bladder cancer (NMIBC) who underwent intravesical BCG treatment
Methods: From August 2005 to May 2017, 327 patients underwent BCG instillation therapy after transurethral resection of bladder tumor. Multivariate Cox regression analysis and Kaplan-Meir curve were used to confirm the predictability for prognosis of NLR and European Organization for Research and Treatment of Cancer trials (EORTC) scoring model.
Results: Of 327 patients, 92 (28.1%) had recurrence and 15 (4.6%) developed progression within a median follow-up of 42 months (range 19â€“129 months). Cut-off value of NLR was 2.29, and 120 patients (36.7%) had high NLR. In the Kaplan-Meir curve, NLR was associated with recurrence (Log rank test, P < 0.001) and progression (Log rank test, P=0.030). EORTC score was associated with recurrence (Log rank test, P=0.003) and progression (Log rank test, P=0.043). Combination of NLR and EORTC score was associated with recurrence (Log rank test, P < 0.001) and progression (Log rank test, P=0.013). In multivariate analysis, high NLR (HR, 1.609; P < 0.001), age (HR, 1.037; P=0.013), gender (HR, 2.352; P=0.240), recurrent tumor (HR, 4.139; P < 0.001) and tumor number (HR, 1.678; P=0.003) were identified as predicting factors of recurrence. High NLR (HR 1.625; P=0.010), CIS (HR, 4.991; P=0.009), and recurrent tumor (HR, 3.997; P=0.027) were identified as predicting factors of progression.
Conclusions: In patients with NMIBC, NLR was identified as a significant predictor of tumor recurrence and progression. The inclusion of preoperative NLR as a predictor may increase the accuracy of the EORTC model to predict disease progression. Therefore, more aggressive management may be recommended in patients with high NLR.