Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker in Patients with Localized Urothelial Carcinoma Treated with Chemotherapy - Expert Commentary
Accordingly, efforts to discover practical, reliable, and cost-effective biomarkers have intensified. Some studies have indicated that systemic inflammatory response biomarkers, such as neutrophil-to-lymphocyte ratio (NLR), are potentially useful in predicting treatment outcomes as they may reflect tumor microenvironment status. von Deimling et al. tested whether NLR could be used as a predictor of prognosis in patients with urothelial carcinoma.
The researchers carried out a retrospective analysis of treatment parameters, clinical outcomes, and pre-treatment blood samples from 404 patients (collected from a multicenter database). Calculated pre-treatment NLR was high in 41.8% of patients. This was significantly associated with a higher probability of adverse pathologic features such as advanced tumor stage and lymph node metastases. High NLR was also associated with a reduced probability of complete and partial responses. In a predictive model that accounted for various factors, such as treatment regimen, age, and clinical tumor stage, the addition of pre-treatment NLR as a variable increased the model’s accuracy in predicting complete or partial response. This was also observed in a subgroup analysis for patients with lymph node involvement.
The median follow-up time was 49 months, during which 33.7% of patients experienced recurrence and 25% died of urothelial carcinoma. The five-year relapse-free survival, cancer-specific survival, and overall survival rates were 62.2%, 69.9%, and 62.5%, respectively. In a Cox regression analysis, high NLR was significantly associated with shorter rates for all three survival measures. Among the patients with lymph node involvement subgroup, the median follow-up was 40 months, during which 55.2% experienced recurrence and 41.4% died of urothelial carcinoma. Within this subgroup, the five-year relapse-free survival, cancer-specific survival, and overall survival rates were 36.9%, 52.2%, and 49.2%, respectively. Elevated pre-treatment NLR is an independent risk factor for lymph node metastasis and response to cisplatin-based NAC. However, it did not meaningfully improve the C-statistic of models that relied on either clinicopathologic variables to predict survival outcomes. Longitudinal prospective studies in which NLR is analyzed over time in a large cohort of patients and across different treatment modalities will be potentially informative in this setting.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
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