Predictive Value Of Pre-operative NLR In Patients With Upper Tract Urothelial Carcinoma

Objective:Preoperative inflammatory factors of peripheral blood are related to recurrence and prognosis of numerous malignancies.This study was designed to investigate the value of pre-operative neutrophil-to-lymphocyteratio(NLR)in the prognosis evaluation of upper tract urothelial carcinoma(UTUC).Methods : The clinical data and follow-up data of patients who underwent radical nephroureterectomy(RUN)during the First Affiliated Hospital of Chongqing Medical University from December 2012 to December 2018 were retrospectively analyzed,including preoperative blood routine data(to calculated NLR),personal history(smoking status,aristolochic acids),open versus endoscopic techniques,postoperative pathological factors(tumor location,pathologic tumor stage,pathologic tumor grade,lymph node Infiltration),and the time of recurrence and death after surgery.The optimal cut-off point was determined by receiver operating characteristic curve(ROC curve),then the patients were divided into high NLR group and low NLR group.Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate Overall survival(OS)and Cancer-specific survival(CSS)between the two groups.Results:A total of 148 patients were included in the final analysis,90 male patients and 58 female patients.The age of patients were from 34 to90 years old,with a median age of 67 years old.59 patients occurred relapse or presented with metastases and 37 died.The median follow-up duration was 27 months.38 patients adopted open RUN and 110 patients adopted laparoscopic RUN.Tumors were located in the renal pelvis in 66 patients,the ureter in 78 patients,and both locations in 4 patients.6patients presented T4 stage tumor,142 patients presented ≤T3 stage.There were 11 patients had lymph node invasion.In addition,113 patients were diagnosed with high-grade urothelial carcinoma while 35 patients with low-grade urothelial carcinoma.The cut-off point of NLR was 4.44,univariate and multivariate Cox regression analysis showed that NLR≥4.44(P<0.001,HR=5.096,95%CI:2.297~11.308;P=0.002,HR=4.401,95%CI:1.697~11.414),open operation,high tumor stages(T4)and high tumor grade(G2)were independent risk factors for OS and CSS.The survival curve showed that low NLR group had significantly better OS(P=0.001)and CSS(P=0.017)than high NLR group.Conclusion : Pre-operative neutrophil-to-lymphocyte ratio of inflammation biomarkers was an independent risk factor of prognosis of UTUC,high NLR suggested a poor prognosis.Thus,patients with high NLR should adopt stricter follow-up strategy,to ameliorate the quality of life and lengthen the survival period.