Bladder cancer invasion predictability based on preoperative neutrophil-lymphocyte ratio

Our plain-English summary of Bladder cancer invasion predictability based on preoperative neutrophil-lymphocyte ratio, by M. Kaynar, M.E. Yıldırım, H. Badem, et al (Tumour Biology, 2014).

The study

• Authors: M. Kaynar, M.E. Yıldırım, H. Badem, M. Caviş, E. Tekinarslan, M.O. Istanbulluoğlu, Ö.F. Karataş, E. Çimentepe
• Journal: Tumour Biology
• Published: 2014;35(7):6601-5
• Cited by: 44 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

An increased pretreatment neutrophil-lymphocyte ratio (NLR) is associated with poor prognosis in colorectal, gastric, and ovarian cancer; malignant mesothelioma; and renal cell carcinoma. The present study aims to define the predictive value of preoperative peripheral blood count NLR in non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive disease (MIBC) patients. There were in total 291 patients, 241 males and 50 females. Out of these, 156 male and 36 female patients were in the NMIBC group and 85 male and 14 female patients in the MIBC group. In the NMIBC group, 172 patients had low-grade and 20 high-grade papillary urothelial carcinoma. The mean age of the patients in the NMIBC group was 64 ± 13, ranging from 27 to 97. The mean age of the patients in MIBC group was 70.5 ± 10, ranging from 27 to 95. A statistically significant relation between patient ages and tumor invasiveness was determined (p = 0.023, 95 % confidence interval (CI) 63.3-66.7). The mean tumor size of the NMIBC group was 2.1 ± 1.09 (cm) (range 0.5-8), and of MIBC group 3.6 ± 1.5 (cm) (range 0.8-9). There was a statistically significant relation between the tumor size and invasiveness (p = 0.002, 95 % CI 2.8-4.4). In the NIMBC group, 149 (77.6 %) of them have NLR ≤ 2.5 and 43 (22.4 %) have NLR > 2.5. Also, in MIBC, 67 (67.7 %) of them have NLR ≤ 2.5 and 32 (32.3 %) have NLR > 2.5. The mean NLR in the NMIBC group was 2.4 ± 0.1 (range 0.08-6.49, 95 % CI 1.52-2.71) and in the MIBC 2.9 ± 0.2 (range 0.08-16.72, 95 % CI 1.67-2.97). In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.028). Platelet-lymphocyte ratio (PLR) of the two groups was also analyzed. The PLR of the NMIBC group was 12.8 ± 15.1 (range 3.38-19.1) and of the MIBC 13.6 ± 8.78 (range 0.18-63), yet there was not any statistically significant difference (p = 0.810, 95 % CI 11.4-14.8) (Table 1). The correlation tests revealed a positive correlation between the age (r = 0.144, p = 0.024), tumor size (r = 0.193, p = 0.02), and tumor invasiveness NLR (r = 0.138, p = 0.031). NLR can be used to determine tumor invasiveness as a cost-effective, common, and simple biomarker in bladder cancer (BC).

In plain English

This retrospective study concerned bladder cancer, not asbestos. Malignant mesothelioma appears only where the authors describe other studies. The authors reviewed records of 291 bladder cancer patients (241 men, 50 women) from several centers who had a bladder tumor removed through the urethra between March 2009 and May 2013. They compared a blood measure, the neutrophil-lymphocyte ratio (NLR), taken the day before surgery, between 192 patients whose cancer had not invaded the bladder muscle and 99 whose cancer had. Mean NLR was 2.4 in the non-muscle-invasive group and 2.9 in the muscle-invasive group, a statistically significant difference (p=0.028). An NLR above 2.5 was found in 43 of 192 (22.4%) non-muscle-invasive patients and 32 of 99 (32.3%) muscle-invasive patients. Muscle-invasive patients were older on average (70.5 versus 64 years) and had larger tumors (3.6 versus 2.1 cm). The platelet-lymphocyte ratio did not differ significantly between groups (p=0.810). The authors concluded that NLR can be used as a cheap, simple marker of tumor invasiveness in bladder cancer. They said further studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective multicenter review of patient records
• Who was studied: 291 bladder cancer patients (241 males, 50 females) from multiple centers who underwent transurethral resection of bladder tumor between March 2009 and May 2013. 192 were in the non-muscle-invasive group (156 male, 36 female) and 99 in the muscle-invasive group (85 male, 14 female). The authors are from urology departments in Konya and Ankara, Turkey.
• Exposure: No asbestos or other fiber exposure was studied. The factor examined was the preoperative neutrophil-lymphocyte ratio from a routine full blood count taken the day before surgery, along with the platelet-lymphocyte ratio, age and tumor size.
• Main results:
  • Mean NLR was 2.4 plus or minus 0.1 in the non-muscle-invasive group and 2.9 plus or minus 0.2 in the muscle-invasive group. The difference was statistically significant (p=0.028).
  • NLR above 2.5 was found in 43 of 192 (22.4%) non-muscle-invasive patients and 32 of 99 (32.3%) muscle-invasive patients.
  • Mean age was 64 plus or minus 13 years in the non-muscle-invasive group and 70.5 plus or minus 10 years in the muscle-invasive group. The relation between age and invasiveness was statistically significant (p=0.023).
  • Mean tumor size was 2.1 plus or minus 1.09 cm in the non-muscle-invasive group and 3.6 plus or minus 1.5 cm in the muscle-invasive group. The relation with invasiveness was statistically significant (p=0.002).
  • Platelet-lymphocyte ratio was 12.8 plus or minus 15.1 in the non-muscle-invasive group and 13.6 plus or minus 8.78 in the muscle-invasive group. The difference was not statistically significant (p=0.810).
  • In univariate correlation, NLR was positively correlated with tumor invasiveness (r=0.138, p=0.031).
• The authors' conclusion: The authors concluded that NLR can be used to determine tumor invasiveness as a cost-effective, common and simple biomarker in bladder cancer. They added that further studies are needed before NLR can be established as a preoperative parameter to predict muscle-invasive disease.

Topics

Medical terms in this study, explained in our Lexicon: Prognosis, Ovarian Cancer, Malignant Mesothelioma, Carcinoma, confidence interval, Biomarker.

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