Validation of the pretreatment derived neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma
Menée à partir de données médicales portant sur une cohorte de 171 patients atteints d'un carcinome urothélial des voies urinaires supérieures et traités entre 1990 et 2012 (durée médiane de suivi : 31 mois), cette étude évalue l'association entre le rapport neutrophiles/lymphocytes avant traitement et la survie spécifique ou la survie globale des patients
Background : The value of a combined index of neutrophil and white cell counts, named derived neutrophil–lymphocyte ratio (dNLR), has recently been proposed as a prognosticator of survival in various cancer types. We investigated the prognostic role of the dNLR in a large European cohort of patients with upper tract urothelial carcinoma (UTUC).
Methods : Data from 171 non-metastatic UTUC patients, operated between 1990 and 2012 at a single tertiary academic centre, were evaluated retrospectively. Cancer-specific- (CSS) as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of the dNLR, multivariate proportional Cox-regression models were applied. Additionally, the influence of the dNLR on the predictive accuracy of the multivariate model was further determined by Harrell’s concordance index (c-index).
Results : The median follow-up period was 31 months. An increased dNLR was statistically significantly associated with shorter CSS (log-rank P=0.004), as well as with shorter OS (log-rank P=0.002). Multivariate analysis identified dNLR as an independent predictor for CSS (hazard ratio, HR=1.16, 95% confidence interval, CI=1.01–1.35, P=0.045), as well as for OS (HR=1.21, 95% CI=1.09–1.34, P<0.001). The estimated c-index of the multivariate model for OS was 0.68 without dNLR and 0.73 when dNLR was added.
Conclusions : Patients with a high pretreatment dNLR could be predicted to show subsequently higher cancer-specific- as well as overall mortality after surgery for UTUC compared with those with a low pretreatment dNLR. Thus, this combined index should be considered as a potential prognostic biomarker in future.
British Journal of Cancer , résumé, 2013