The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy

Int J Clin Oncol. 2017 Feb;22(1):153-158. doi: 10.1007/s10147-016-1040-7. Epub 2016 Sep 10.


Background: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with recurrence and poor prognosis in numerous cancer types. The aim of this study was to evaluate the use of the NLR as a biomarker for intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) for the first time.

Methods: We retrospectively analyzed the records of 100 patients with UTUC who had undergone RNU between 1999 and 2015 at our institution. The association between the preoperative NLR and IVR were assessed using multivariate models.

Results: Among the 100 patients enrolled in the study, 33 developed IVR during a median follow-up of 34 months. The receiver operating characteristic analysis revealed that the optimum cut-off value for the preoperative NLR was >3.8. A high preoperative NLR (n = 21) was associated with a significantly increased risk of lymph node involvement (p = 0.036) and IVR (p = 0.034) compared with a low preoperative NLR (n = 79). IVR-free survival in patients with a high preoperative NLR was significantly worse than that of patients with a low preoperative NLR (p = 0.018). On multivariate analysis, the preoperative NLR [hazard ratio (HR) 2.49; p = 0.015] and tumor multifocality (HR 2.96; p = 0.024) were independent risk factors predictive of IVR.

Conclusion: In our study population of patients with UTUC who had undergone RNU the preoperative NLR was associated with a significantly increased risk of IVR, suggesting that the NRL could be a useful biomarker for predicting IVR.

Keywords: Intravesical recurrence; Nephroureterectomy; Neutrophil-to-lymphocyte ratio; Upper urinary tract urothelial carcinoma.

MeSH terms

  • Aged
  • Carcinoma, Transitional Cell / blood*
  • Carcinoma, Transitional Cell / secondary
  • Carcinoma, Transitional Cell / surgery
  • Female
  • Humans
  • Lymphatic Metastasis
  • Lymphocyte Count
  • Lymphocytes*
  • Male
  • Neoplasm Recurrence, Local / blood*
  • Nephrectomy
  • Neutrophils*
  • Preoperative Period
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Ureter / surgery
  • Ureteral Neoplasms / blood*
  • Ureteral Neoplasms / pathology
  • Ureteral Neoplasms / surgery
  • Urinary Bladder Neoplasms / blood*
  • Urinary Bladder Neoplasms / secondary