The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy

Anna J Black, Homayoun Zargar, Kamran Zargar-Shoshtari, Adrian S Fairey, Laura S Mertens, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobsen, Joshua Griffin, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Nicholas J Campain, Wassim Kassouf, Marc A Dall'Era, Jo-An Seah, Cesar E ErcoleSimon Horenblas, John S McGrath, Jonathan Aning, Shahrokh F Shariat, Jonathan L Wright, Andrew C Thorpe, Todd M Morgan, Jeff M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Yair Lotan, Petros Grivas, Andrew J Stephenson, Jay B Shah, Bas W van Rhijn, Philippe E Spiess, Siamak Daneshmand, Srikala S Sridhar, Peter C Black

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) is an attractive marker because it is derived from routine bloodwork. NLR has shown promise as a prognostic factor in muscle invasive bladder cancer (MIBC) but its value in patients receiving neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is not yet established. Since NLR is related to an oncogenic environment and poor antitumor host response, we hypothesized that a high NLR would be associated with a poor response to NAC and would remain a poor prognostic indicator in patients receiving NAC.

METHODS: A retrospective analysis was performed on patients with nonmetastatic MIBC (cT2-4aN0M0) who received NAC prior to RC between 2000 and 2013 at 1 of 19 centers across Europe and North America. The pre-NAC NLR was used to split patients into a low (NLR ≤ 3) and high (NLR > 3) group. Demographic and clinical parameters were compared between the groups using Student's t test, chi-squared, or Fisher's exact test. Putative risk factors for disease-specific and overall survival were analyzed using Cox regression, while predictors of response to NAC (defined as absence of MIBC in RC specimen) were investigated using logistic regression.

RESULTS: Data were available for 340 patients (199 NLR ≤ 3, 141 NLR > 3). Other than age and rate of lymphovascular invasion, demographic and pretreatment characteristics did not differ significantly. More patients in the NLR > 3 group had residual MIBC after NAC than the NLR ≤ 3 group (70.8% vs. 58.3%, P = 0.049). NLR was the only significant predictor of response (odds ratio: 0.36, P = 0.003) in logistic regression. NLR was a significant risk factor for both disease-specific (hazard ratio (HR): 2.4, P = 0.006) and overall survival (HR:1.8, P = 0.02).

CONCLUSION: NLR > 3 was associated with a decreased response to NAC and shorter disease-specific and overall survival. This suggests that NLR is a simple tool that can aid in MIBC risk stratification in clinical practice.

Original languageEnglish
Pages (from-to)3.e17-3.e27
JournalUrologic Oncology: Seminars and Original Investigations
Issue number1
Early online date31 Oct 2019
Publication statusPublished - 1 Jan 2020


  • MIBC
  • NLR
  • Neoadjuvant chemotherapy
  • Radical cystectomy
  • Urothelial carcinoma


Dive into the research topics of 'The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy'. Together they form a unique fingerprint.

Cite this