Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinoma

World J Urol. 2013 Aug;31(4):953-8. doi: 10.1007/s00345-012-0942-x. Epub 2012 Sep 13.


Purpose: Preoperative elevation of markers of systemic inflammation is associated with a poor outcome in several cancers. The purpose of this study was to evaluate the prognostic significance of preoperative systemic inflammatory markers in patients with non-metastatic upper urinary tract cancer (UUTC).

Methods: The records of 84 patients with non-metastatic UUTC who had undergone nephroureterectomy were reviewed, and the associations between preoperative clinical variables and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses.

Results: Clinical tumor stage, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly associated with RFS in univariate analysis. Multivariate analysis showed that clinical T stage (hazard ratio [HR], 3.009; 95 % confidence interval [CI], 1.149-9.321; p = 0.024) and neutrophil count (HR, 3.521; 95 % CI, 1.423-9.108; p = 0.007) were independent predictors of RFS. The 3-year RFS in patients with a neutrophil count <4,000/μL was significantly higher than that in patients with a neutrophil count ≥ 4,000/μL (82.9 vs. 51.0 %, p = 0.004). Based on clinical T stage (T2 or less vs. T3 or greater) and neutrophil count (<4,000 vs. ≥ 4,000/μL), patients were stratified into 3 groups: low, intermediate, and high risk groups. RFS rates were significantly different between the 3 groups (p = 0.0005).

Conclusions: Preoperative neutrophil count was an independent predictor of RFS in patients with non-metastatic UUTC. Stratification of patients based on neutrophil count and clinical T stage may be valuable for preoperative patient counseling and identifying patients with poor prognosis who may be candidates for neoadjuvant chemotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Leukocyte Count
  • Male
  • Middle Aged
  • Nephrectomy
  • Neutrophils / pathology*
  • Predictive Value of Tests
  • Preoperative Period
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome
  • Ureter / surgery
  • Urologic Neoplasms / blood*
  • Urologic Neoplasms / diagnosis*
  • Urologic Neoplasms / surgery
  • Urologic Surgical Procedures