Preoperative neutrophil/lymphocyte ratio as a prognosticator in upper tract urothelial carcinoma patients treated conservatively
To prospectively evaluate the prognostic value of neutrophil/lymphocyte ratio (NLR) in patients with upper tract urothelial carcinoma (UTUC).
Since 2016 we prospectively evaluated 30 consecutive patients (group 1) compared to retrospectively 130 consecutive patients (2005-2015) (group 2) who underwent RIRS (retrograde intra renal surgery) for UTUC. We applied EAU guidelines follow-up scheme: endoscopic control and cytology initially every 3 months, then every 6 months for 2 years and once a year; yearly Uro-CT. From patient records white blood cells (WBC), platelet (PLT), neutrophil (N), lymphocyte (L) counts were collected. NLR was derived by dividing N by L. These data were compared with tumor characteristics: stage (Ta vs. T1), grade (G1 vs. ≥G2), focality (single vs. multiple), site (ureter vs. kidney±ureter), and size (≤1 cm vs. >1 cm). The endpoints were: recurrence at the first follow-up, multiple recurrences during follow-up, and progression. They were stratified by the NLR cut-off point, according to the receiver operating characteristic analysis. T-test and chi-square test were used to evaluate parametric and non parametric variables. Statistical significance was considered at p<0,05.</p>
The average NLR value was 2.90±1.05 in group 1 and 3.48±1.92 in group 2. Significantly higher NLR values were observed in patients with ≥pT1 (p=0.03 and p=0.0001 in group 1 and in group 2, respectively), ≥G2 (p=0.03 and p=0.0009), multifocal (p=0.01 and p=0.028), >1 cm tumor (p=0.04 and p=0.0001). The optimum cut-off value for NLR was 3 for all the endpoints. Patients with NLR>3 exhibited a risk of recurrence at first follow-up 3-5 times higher (p=0.04, OR 5.33 in group 1 and p=0.007, OR 2.94 in group 2), a risk of multiple recurrences 1.5-7 times higher (p=0.02, OR 7.33 in group 1 and p=0.006, OR 1.54 in group 2). No disease progression was observed in group 1 while Patients with NLR>3 in group 2 exhibited a risk of disease progression 5 times higher (p=0.04, OR 5.00).
The preoperative evaluation of NLR provides valuable prognostic information for the clinical management of UTUC patients treated conservatively. High NLR was associated with higher recurrence and progression rates. It may identify those needing more frequent endoscopic follow-up, and lower thresholds to conversion to more aggressive surgical strategies except. Prospective multicenter studies are needed to validate the role of NLR as a prognosticator of recurrence and progression in these patients.