Preoperative Monocyte-to-Lymphocyte Ratio Predicts For Intravesical Recurrence And Prognosis In Patients With Urothelial Carcinoma Of The Upper Urinary Tract After Radical Nephroureterectomy

Background:This study aimed to investigate the preoperative Monocyte-toLymphocyte Ratio(MLR)as a biomarker for intravesical recurrence(IVR)and prognosis in upper urinary tract urothelial carcinoma(UTUC)after radical nephroureterectomy(RNU).Method:This study involved the clinical data of 255 patients with UTUC without a history of bladder cancer who had undergone RNU from March 2004 to February 2019 at an academic institutions.The optimal cutoff value of MLR was set as 0.22 by using the median.Next,the cohort was divided into 2 groups:121 patients with low MLR((0.22)and 134 patients with high MLR(>0.22).x2 test was used to detect the association between MLR and clinicopathological variables.Survival analyses were performed using the Kaplan-Meier method and were compared using the log-rank test.The associations between MLR and IVR,OS,PFS were assessed with Cox regression analysis.Result:The median follow-up was 43.93 months.Of the 255 patients,37 had developed IVR during the follow-up period.62 patients died,88 patients experienced disease progression.Kaplan-Meier analysis revealed that patients with high MLR(>0.22)had poor IVR-free survival(P=0.001),OS(P=0.011)and PFS(P=0.001).Cox regression preoperative models showed that ureteral tumor site(hazard ratio[HR]2.784;P=0.005),surgical approach(HR 2.745;P=0.008),and high MLR(HR 4.085;P<0.001)were an independent risk factor for IVR.Multivariate analysis identified risk factors associated with OS,PFS in UTUC patients following RNU:male(HR=1.790,P=0.030)、tumor site(HR=1.823,P=0.026)、advanced pT stage(HR=2.045,P=0.011)、lymph node involvement(HR=3.734,P=0.004)and elevated pre-MLR(HR=1.767,P=0.037)was an independent risk factor for predicting OS;tumor site(HR=1.915,P=0.004)、presence of lymph node metastasis(HR=7.196,P<0.001)、LVI(HR=2.396,P=0.005)、IVR(HR=9.292,P<0.001)and elevated pre-MLR(HR=1.927,P=0.008)were the independent risk factors for PFS.These factors used as a signature to establish a prognostic risk model,which revealed significant differences among the 3 subgroups of patients with low,intermediate,and high risk(All P<0.001).Conclusion:Elevated pre-MLR was an independent risk factor of IVR,OS and PFS in UTUC patients managed by RNU.MLR may become a useful biomarker to predict IVR in patients with UTUC after RNU.