Subclassification of upper urinary tract urothelial carcinoma by the neutrophil-to-lymphocyte ratio (NLR) improves prediction of oncological outcome.

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Neutrophil to lymphocyte ratio (NLR) is thought to be a prognostic factor of several malignancies. Neutrophilia was reported to be associated with prognosis of upper urinary tract cancer. This study examine the potential role of NLR as subclassification for localized upper urinary tract cancer PATIENTS AND METHODS: From 2004 to 2010, 234 patients with localized UUT-UC underwent radical nephroureterectomy. NLR were only obtained under afebrile condition before radical surgery. Patients underwent neoadjuvant or adjuvant chemotherapy were excluded Prognostic impact of NLR was assessed with the log rank test and multivariate analyses. Only advanced pathological stage of more than T2 and NLR more than 3 were independently associated with metastasis (p<0.001 and p=0.02 respectively) and cancer specific mortality (p=0.002 and p=0.006 respectively). The use of NLR > 3 further identified the poor prognostic group especially in patients with T3 UUT-UC in metastasis free survival and cancer specific survival (Log rank test, both p<0.001). For localized UUT-UC, pathological stage and preoperative NLR independently predicts systemic recurrence and cancer specific death after RNU. Using NLR as subclassification of T3 UUT-UC seems to further identify the poor prognostic group and may help with clinical decisions regarding treatment intervention in clinical practice.