NLR Identified as Potential Prognostic Biomarker in Patients With UTUC

The neutrophil-to-lymphocyte ratio (NLR) may be a significant prognostic biomarker and predict adverse clinicopathological characteristics in patients with upper tract urothelial carcinoma (UTUC), according to a recent analysis.

NLR is a reliable prognostic biomarker for several cancers, but its applicability to UTUC is still debated. A retrospective analysis led by Rudra Prasad Ghorai, MBBS, and colleagues aimed to determine the prognostic cutoff of NLR for clinicopathological outcome predictions in patients with UTUC who underwent radical nephroureterectomy (RNU).

NLR was calculated using the neutrophil and lymphocyte counts one day before surgery, the cutoff value was set as a 2.5 on the Kaplan-Meier estimator, and Cox proportional hazards regression was used to analyze the association between NLR and ontological outcomes.

The final analysis included data collected between July 2012 and December 2022 from 91 patients with a median follow-up of 49 months. For patients with NLR < 2.5, the mean age was 56.88 years; for patients with NLR ≥ 2.5, the mean age was 56.35 years. The pathological stages were pT1 in 48% of participants, pT1 in 20.88%, pT3 in 27.47%, and pT1 in 3.30%.

Multivariable Cox regression analysis showed that preoperative NLR ≥ 2.5 was significantly associated with higher T stage, lymphovascular invasion, necrosis, nodal involvement, adjuvant chemotherapy, and worse overall survival (OS). Cox regression analysis also found that only the higher stage of disease was associated with a heightened risk for recurrence (hazard ratio [HR], 7.90; 95% CI, 1.95-31.91; P=.004).

Kaplan-Meier survival analysis revealed that preoperative NLR ≥ 2.5 was an independent risk factor for OS (HR, 9.87; P=.03), but the association with recurrence-free survival was not statistically significant (HR, 1.14; P=.82).

“The present study shows the impact of preoperative NLR on the prognosis of patients with UTUC and incorporating NLR in the current risk stratification parameters may help in superior risk stratification as well as management of patients with UTUC,” Dr. Ghorai and colleagues concluded.