Low Pretreatment Neutrophil-to-Lymphocyte Ratio Predicts for Good Outcomes in Patients Receiving Neoadjuvant...

Area of Science:

• Oncology
• Immunology
• Urology

Background:

• The neutrophil-to-lymphocyte ratio (NLR) is linked to cancer prognosis and treatment response.
• Muscle invasive bladder cancer (MIBC) is a significant clinical challenge.
• Neoadjuvant chemotherapy (NAC) is a critical treatment modality for MIBC.

Purpose of the Study:

• To investigate the predictive role of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in outcomes for patients with muscle invasive bladder cancer (MIBC) undergoing neoadjuvant chemotherapy (NAC).
• To determine if NLR can serve as a biomarker for treatment response and survival in MIBC patients receiving NAC.

Main Methods:

• Retrospective analysis of 205 MIBC patients treated with NAC and radical cystectomy (2007-2015).
• Evaluation of pretreatment clinicopathologic factors, including NLR, as predictors of outcomes.
• Statistical analysis using uni- and multivariate analyses, Kaplan-Meier curves, Cox regression, and log-rank tests to assess relationships with progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

Main Results:

• Of 75 patients receiving NAC, a pretreatment NLR predicted pathologic response (PR), PFS, CSS, and OS on multivariate analysis (P < .05 for all).
• A NLR threshold of 2.26 demonstrated better prediction for CSS (P < .05) and OS (P = .055).
• NLR, in combination with age and clinical stage, predicted PR.

Conclusions:

• A low pretreatment NLR is associated with favorable outcomes in MIBC patients treated with NAC, suggesting the immune system's role in treatment response.
• The NLR is a simple, accessible biomarker that can potentially enhance therapeutic algorithms and decision-making for NAC in MIBC.
• Further validation is needed, but NLR shows promise as a prognostic and predictive tool in MIBC management.