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Category: Volume 06 Issue 05 May 2018
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Title: Diagnostic Value of Pre treatment Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Lymphocyte-to-Monocyte Ratio for Invasive Bladder Carcinoma

Authors: N. Madhavan, A. T. Rajeevan, Edikkula Varghese, K. Rajeevan, Manikandan, A. V. Venugopal, Shanmugha Das.K.V, Felix Cardoza

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.177

Abstract

Purpose: Oncologic outcomes in diverse malignancies are associated with inflammation-based prognostic scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). In this study, we evaluated the predictive value of pre treatment prognostic scores in differentiating muscle invasive (MIBC) and non muscle invasive (NMIBC) bladder cancer.

Materials and Methods: This prospective cross sectional study analysed consecutive transurethral resection of bladder tumour (TURBT) cases from September 2016 to December 2017. Demographics of patients, characteristics of tumour and prognostic scores results were recorded. Prognostic score cut offs were determined using receiver operating characteristics curves. The association between variables and MIBC were evaluated by performing univariate and multivariate binomial logistic regression analysis.

Results: Total patients included were 142. Of this 96 were having NMIBC (stage T1) and 46 were having MIBC (stage T2+). Median age was 75 years. 128 patients were male(90.1%) and 14 were female(9.9%). The NLR had the greatest area under the curve (AUC) of 0.748 (cut off was 3.89), followed by LMR (cutoff<1.8; AUC, 0.644) and PLR (cut off>218; AUC, 0.596). Univariate analysis identified NLR, PLR, LMR, Tumour size and Tumour multiplicity as significant predictors of muscle-invasive bladder cancer (MIBC) Table: 15. The multivariate logistic regression model identified NLR (OR, 11.822; 95% CI, 4.492 – 31.112; p=0.001) and tumour size (OR, 6.306; 95% CI, 1.563 – 25.436; p=0.010) as independent predictors of muscle-invasive bladder cancer (MIBC).

Conclusions: NLR may be used as a simple, cost-effective and easily measured marker for MIBC. It can be performed at the time of diagnostic cystoscopy, and can be used in the planning of further treatment.

Keywords: Urinary bladder neoplasms; Blood platelets; Neutrophils; Lymphocytes.

References

  1. Cancer statistics, 2016.Siegel RL, Miller KD, Jemal A. CA Cancer J Clin. 2016 Jan-Feb;66(1):7-30. doi: 10.3322/caac.21332. Epub 2016 Jan 7. PMID:2674299
  2. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860–867.
  3. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E, et al. update 2013. Eur Urol 2013;64:639–653.
  4. Dutta SC, Smith JA Jr, Shappell SB, Coffey CS, Chang SS, Cookson MS. Clinical under staging of high risk nonmuscle invasive urothelial carcinoma treated with radical cystectomy. J Urol 2001;166:490–493.
  5. Kumar R, Geuna E, Michalarea V, Guardascione M, Naumann U, Lorente D, et al. The neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer 2015;112:1157–1165.
  6. Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer 2012;107:695–699.
  7. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol 2010;6:149–163.
  8. Zhou X, Du Y, Huang Z, Xu J, Qiu T, Wang J, et al. Prognostic value of PLR in various cancers: a meta-analysis. PLoS One 2014;9:e101119.
  9. Can C, Baseskioglu B, Yılmaz M, Colak E, Ozen A, Yenilmez A. Pretreatment parameters obtained from peripheral blood sample predicts invasiveness of bladder carcinoma. Urol Int 2012;89:468–472.
  10. Ceylan C, Doluoglu OG, Keles I, Gazel E, Temucin T, Odabas O, et al. Importance of the neutrophil-to-lymphocyte ratio in muscle-invasive and non-muscle invasive bladder tumors. Urologia 2014;81:120–124.
  11. Kaynar M, Yıldırım ME, Badem H, Cavis M, Tekinarslan E, Istanbulluoglu MO, et al. Bladder cancer invasion predictability based on preoperative neutrophil-lymphocyte ratio. Tumour Biol 2014;35: 6601–6605.
  12. Su-Min Lee, Andrew Russell, and Giles Hellawell ,Korean J Urol. 2015 Nov;56(11):749-755. Predictive value of pretreatment inflammation-based prognostic scores for invasive bladder carcinoma.
  13. Shariat SF, Palapattu GS, Karakiewicz PI, Rogers CG, Vazina A, Bastian PJ, et al. Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy. Eur Urol 2007;51:137–149.
  14. Ark JT, Keegan KA, Barocas DA, Morgan TM, Resnick MJ, You C, et al. Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU Int 2014;113:894–899.
  15. Karakiewicz PI, Shariat SF, Palapattu GS, Gilad AE, Lotan Y, Rogers CG, et al. Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder. J Urol 2006;176(4 Pt 1):1354–1361.
  16. Margel D, Harel A, Yossepowitch O, Baniel J. A novel algorithm to improve pathologic stage prediction of clinically organ-confined muscle-invasive bladder cancer. Cancer 2009;115:1459–1464.
  17. Bostrom PJ, Van Rhijn BW, Fleshner N, Finelli A, Jewett M, Thoms J, et al. Staging and staging errors in bladder cancer. Eur Urol Suppl 2010;9:2–9.
  18. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006;49:466–465.
  19. Zahorec R. Ratio of neutrophil to lymphocyte counts: rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.
  20. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 2014;23:31–39.
  21. Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G, et al. Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int 2012;109: 1666–1673.
  22. Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK. Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy. J Endourol 2013;27:1046–1050.
  23. Potretzke A, Hillman L, Wong K, Shi F, Brower R, Mai S, et al. NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder. Urol Oncol 2014;32:631–636.
  24. Viers BR, Boorjian SA, Frank I, Tarrell RF, Thapa P, Karnes RJ, et al. Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Eur Urol 2014;66:1157–1164.
  25. Mano R, Baniel J, Shoshany O, Margel D, Bar-On T, Nativ O, et al. Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer. Urol Oncol 2015;33:67.e1–67.e7.
  26. Ozyalvacli ME, Ozyalvacli G, Kocaaslan R, Cecen K, Uyeturk U, Kemahlı E, et al. Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer. Can Urol Assoc J 2015;9:E126–E131.
  27. Witjes JA, Comperat E, Cowan NC, De Santis M, Gakis G, Lebret T, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2014;65:778–792.

Corresponding Author

A. T. Rajeevan

Government Medical College, Kozhikode, Kerala, India