The Prognostic Significance of the Early Postoperative Neutrophil-to-Lymphocyte Ratio in Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy

Minyong Kang, Chang Wook Jeong, Cheol Kwak, Hyeon Hoe Kim, Ja Hyeon Ku

Because the pretreatment neutrophil-to-lymphocyte ratio (NLR) is a reliable prognostic factor, the authors of this study hypothesized that posttreatment NLR also predicts the survival outcome for cancer patients. The study investigated the clinicopathologic features according to postoperative NLR and determined the prognostic significance of early postoperative NLR for bladder cancer patients undergoing radical cystectomy (RC). The study reviewed 385 bladder cancer patients treated with RC and pelvic lymph node dissection at the authors' institution between 1999 and 2012. The primary end points of the study were cancer-specific survival (CSS) and overall survival (OS) estimates from the Kaplan-Meier analysis. Multivariate Cox regression analysis was adopted to identify the independent prognostic factors for oncologic outcomes after surgery. Patients with elevated postoperative NLR (≥2.0) had higher rates of advanced pathologic tumor stage (≥pT3), lymphovascular invasion, and lymph node involvement. Notably, they showed poorer CSS and OS rates than patients with a postoperative NLR lower than 2.0. Additionally, patients with pre- and postoperative elevated NLR (≥2.1 → ≥2.0) demonstrated worse oncologic outcomes than other groups of NLR changes. Multivariate analysis showed that early postoperative NLR remained a key predictor for CSS and OS. When divided by pathologic T or N stage, patients with localized pathologic T stage or pN0 status showed significant differences in survival according to early postoperative NLR. In summary, postoperative NLR in the early recovery period can be a valuable biomarker for predicting oncologic outcomes for bladder cancer patients undergoing RC.