Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy
Abstract
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
References
- 1. . Epidemiology of bladder cancer. Med.Sci. (Basel) 8(1), 15 (2020). • Updated data.
- 2. . Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 115(1), 68–74 (2009).
- 3. . Association between smoking and risk of bladder cancer among men and women. JAMA 306(7), 737–745 (2011).
- 4. Association of NAFLD and insulin resistance with non metastatic bladder cancer patients: a cross-sectional retrospective study. J. Clin. Med. 10(2), 346 (2021). • Novel research.
- 5. Epidemiology and risk factors of urothelial bladder cancer. Eur. Urol. 63(2), 234–241 (2013).
- 6. . Molecular and histopathology directed therapy for advanced bladder cancer. Nat. Rev. Urol. 16(8), 465–483 (2019).
- 7. The tumor immune microenvironment drives a prognostic relevance that correlates with bladder cancer subtypes. Cancer Immunol. Res. 7(6), 923–938 (2019).
- 8. . Preoperative Glasgow prognostic score as a predictor of primary bladder cancer recurrence. Mol. Clin. Oncol. 5(1), 201–206 (2016).
- 9. . Bladder cancer: diagnosis and treatment. Am. Fam. Physician 96(8), 507–514 (2017).
- 10. Laparoscopic radical cystectomy with extracorporeal urinary diversion: an Italian single-center experience with 10-year outcomes. Minerva Urol. Nefrol. 72(5), 641–643 (2020).
- 11. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis. Oncologist 21(6), 708–715 (2016).
- 12. Neoadjuvant cisplatinum based combination chemotherapy in patients with invasive bladder cancer: a combined analysis of two Nordic studies. Eur. Urol. 45(3), 297–303 (2004). •• Basic clinical investigation.
- 13. Advanced bladder cancer (ABC) meta-analysis collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data. Eur. Urol. 48(2), 202–205; discussion 205–206 (2005). • Interesting research.
- 14. Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer. Eur. Urol. 61(6), 1229–1238 (2012).
- 15. European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur. Urol. 79(1), 82–104 (2021). • Updated data.
- 16. Cancer treatment and survivorship statistics, 2014. CA Cancer J. Clin. 64(4), 252–271 (2014).
- 17. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Sci. Rep. 8(1), 1–9 (2018).
- 18. Meta-analysis of multiple hematological biomarkers as prognostic predictors of survival in bladder cancer. Medicine 99(30), e20920 (2020).
- 19. The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy. In: Urologic Oncology: Seminars and Original Investigations. Elsevier, 3.e17–13.e27 (2020). • Novel research.
- 20. The prognostic role of the change in neutrophil-to-lymphocyte ratio during neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: a retrospective, multi-institutional study. Bladder Cancer 4(2), 185–194 (2018).
- 21. Association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a retrospective cohort study. BMJ Open 10(10), e039860 (2020).
- 22. . NARCA: a novel prognostic scoring system using neutrophil-albumin ratio and Ca19-9 to predict overall survival in palliative pancreatic cancer. J. Surg. Oncol. 118(4), 680–686 (2018).
- 23. NARFIB: a novel prognostic score based on the neutrophil-to-albumin ratio and fibrinogen can predict the prognosis of gastrointestinal stromal tumors. Cancer Manag. Res. 12, 11183–11190 (2020).
- 24. . The neutrophil to albumin ratio as a predictor of pathological complete response in rectal cancer patients following neoadjuvant chemoradiation. Anticancer Drugs 27(9), 879–883 (2016).
- 25. . Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock. Epidemiol. Infect. 148, e87–e87 (2020).
- 26. . The neutrophil percentage to albumin ratio as a new predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction. Med. Sci. Monit. 25, 7845–7852 (2019).
- 27. Association between neutrophil percentage-to-albumin ratio and all-cause mortality in critically ill patients with coronary artery disease. Biomed. Res. Int. 2020, 8137576 (2020). • Interesting clinical investigation.
- 28. . The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in critically ill patients with acute kidney injury. Biomed. Res. Int. 2020, 5687672 (2020).
- 29. Validation of neutrophil-to-lymphocyte ratio in a multi-institutional cohort of patients with T1G3 non-muscle-invasive bladder cancer. Clin. Genitourin. Cancer 16(6), 445–452 (2018). •• Interesting clinical investigation.