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Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy

    Matteo Ferro

    *Author for correspondence:

    E-mail Address: matteo.ferro@ieo.it

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    ,
    Dragoş-Florin Babă‡

    Department of Cell & Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania

    Cardiovascular Disease and Transplant Institute, Department of Urology, Targu Mures, Romania

    ‡Authors contributed equally

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    ,
    Ottavio de Cobelli

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    Department of Oncology & Haematology-Oncology, University of Milan, Milan, Italy

    ,
    Gennaro Musi

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    Department of Oncology & Haematology-Oncology, University of Milan, Milan, Italy

    ,
    Giuseppe Lucarelli

    Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy

    ,
    Daniela Terracciano

    Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

    ,
    Angelo Porreca

    Department of Oncological Urology, Veneto Institute of Oncology IOV, IRCSS, Padua, Italy

    ,
    Gian Maria Busetto

    Department of Urology, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, Rome, Italy

    ,
    Francesco Del Giudice

    Department of Urology, ‘Sapienza’ University of Rome, Policlinico Umberto I Hospital, Rome, Italy

    ,
    Francesco Soria

    Division of Urology, Department of Surgical Sciences, AOU Citta´ della Salute e della Scienza, Turin School of Medicine, Turin, Italy

    ,
    Paolo Gontero

    Division of Urology, Department of Surgical Sciences, AOU Citta´ della Salute e della Scienza, Turin School of Medicine, Turin, Italy

    ,
    Francesco Cantiello

    Department of Urology, University of Catanzaro, Università ‘Magna Græcia’, Catanzaro, Italy

    ,
    Rocco Damiano

    Department of Urology, University of Catanzaro, Università ‘Magna Græcia’, Catanzaro, Italy

    ,
    Papalia Rocco

    Department of Urology, Policlinic University Campus of Bio-Medicine of Rome, Rome, Italy

    ,
    Roberto Mario Scarpa

    Department of Urology, Policlinic University Campus of Bio-Medicine of Rome, Rome, Italy

    ,
    Abdal Rahman Abu Farhan

    Department of Urology, University of Catanzaro, Università ‘Magna Græcia’, Catanzaro, Italy

    ,
    Riccardo Autorino

    Division of Urology, Virginia Commonwealth University Health System, Richmond, VA 23298, USA

    ,
    Antonio Brescia

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    ,
    Michele Marchioni

    Department of Medical, Oral & Biotechnological Sciences, Gabriele d'Annunzio University of Chieti & Pescara, Chieti, Italy

    ,
    Andrea Mari

    Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy

    ,
    Andrea Minervini

    Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy

    ,
    Nicola Longo

    Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy

    , ,
    Sisto Perdona’

    Division of Urology, National Cancer Institute IRCCS Pascale Foundation, Naples, Italy

    ,
    Biagio Barone

    Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy

    ,
    Pietro De Placido

    Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, Italy

    ,
    Michele Catellani

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    ,
    Danilo Bottero

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    ,
    Pasquale Ditonno

    Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy

    ,
    Michele Battaglia

    Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy

    ,
    Stefania Zamboni

    Department of Urology, ASST Spedali Civili di Brescia, Brescia, Italy

    ,
    Alessandro Antonelli

    Department of Urology, ASST Spedali Civili di Brescia, Brescia, Italy

    Department of Urology, University of Verona, Verona, Italy

    ,
    Francesco Greco

    Clinic of Urology, Centro Salute Uomo, Bergamo, Italy

    ,
    Giorgio Ivan Russo

    Department of Urology, University of Catania, Catania, Italy

    ,
    Salvatore Smelzo

    Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy

    ,
    Rodolfo Hurle

    Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy

    ,
    Nicolae Crisan

    Department of Urology, University of Medicine & Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania

    ,
    Matteo Manfredi

    Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy

    ,
    Francesco Porpiglia

    Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy

    ,
    Felice Crocetto

    Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy

    ,
    Carlo Buonerba

    Department of Oncology & Hematology, Regional Reference Center for Rare Tumors, University of Naples Federico II, Naples, Italy

    National Reference Center for Environmental Health, Zoo-prophylactic Institute of Southern Italy, Portici, Italy

    ,
    Alina Danilesco

    Department of Cell & Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania

    &
    Mihai Dorin Vartolomei

    Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy

    Department of Cell & Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania

    Department of Urology, Medical University of Vienna, Wien, Austria

    Published Online:https://doi.org/10.2144/fsoa-2021-0008

    Aim: To investigate the prognostic role of neutrophil percentage-to-albumin ratio (NPAR) in muscle-invasive bladder cancer (MIBC) patients treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Patients & methods: 213 patients were included. Inclusion criteria: Nonmetastatic, MIBC (cT2-T4aN0M0), at least three cycles of NAC, undergone RC and with blood count within 30 days before NAC. Results: Five-years overall survival (OS) with NPAR >18 was 34.06% (95% CI: 18.3–50.5) and 65.37% (95% CI: 52.4–75.6) with NPAR <18. Five years cancer-specific survival (CSS) with NPAR >18 was 42.9% (95% CI: 23.9–60.7) and 74.5% (95% CI: 62.6–83.1) with NPAR <18 (p < 0.001). In multivariable analysis, NPAR increased OS of 1.3 points and CSS of 4.37 points. Conclusion: High NPAR prior to NAC seems to be a strong predictor of OS and CSS in MIBC patients treated with NAC and RC.

    Lay abstract

    This research demonstrated that presence of a high neutrophil percentage-to-albumin ratio in patients with muscle-invasive bladder cancer prior neoadjuvant chemotherapy and radical cystectomy is associated with worse outcomes and reduced overall and cancer-specific survival. Thus, neutrophil percentage-to-albumin ratio could be a useful biological marker in clinical practice to help predict outcomes for patients with muscle-invasive bladder cancer.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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