Preoperative neutrophil/lymphocyte ratio as a prognosticator in upper tract urothelial carcinoma patients treated conservatively: a retrospective evaluation
To evaluate the potential prognostic value of neutrophil/lymphocyte ratio (NLR) (expression of the involvement of systemic inflammation in neoplastic growth and progression) in patients with upper tract urothelial carcinoma (UTUC) treated conservatively.
We retrospectively evaluated 130 consecutive patients who underwent RIRS (retrograde intra renal surgery) for UTUC. From patient records, the following values (performed preoperatively): white blood cells (WBC), platelet (PLT), neutrophil (N), lymphocyte (L) counts, were retrospectively 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.
The average NLR value was 3.48±1.92. Significantly higher NLR values were observed in patients with ≥pT1 (p=0.0001), ≥G2 (p=0.0009), multifocal (p=0.028), >1 cm tumor (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 times higher (p=0.007, OR 2.94), a risk of multiple recurrences 1,5 times higher (p=0.006, OR 1.54), and 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 selection and clinical management of UTUC patients treated conservatively. These data show that high NLR (>3) was associated with higher recurrence and progression rates. It may identify those needing more frequent endoscopic follow-up with biopsies, and lower thresholds to conversion to more aggressive surgical strategies except in imperative situations. Prospective multicenter studies with larger study populations are needed to validate the role of NLR >3, as a prognosticator of recurrence and progression in patients with UTUC treated conservatively, before incorporation into international practice guidelines.