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Clinical significance of prognosis using the neutrophil–lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma
Author(s) -
Sung Hyun Hwan,
Gyun Jeon Hwang,
Jeong Byong Chang,
Seo Seong Il,
Jeon Seong Soo,
Choi HanYong,
Lee Hyun Moo
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12846
Subject(s) - medicine , hazard ratio , neutrophil to lymphocyte ratio , gastroenterology , erythrocyte sedimentation rate , confidence interval , urology , clinical significance , stage (stratigraphy) , lymph node , lymphocyte , paleontology , biology
Objectives To evaluate the clinical significance of preoperative erythrocyte sedimentation rate ( ESR ) and neutrophil–lymphocyte ratio ( NLR ) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma ( UTUC ). Patients and Methods A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0–22 mm/h in men and 0–27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I , n = 169), and those with both elevated ESR and elevated NLR (group II , n = 73). Results The median patient age was 64 years and the median follow‐up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLR s and ESR s, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status ( P < 0.05). Preoperative ESR (hazard ratio [ HR ] 1.784, 95% confidence interval [ CI ] 1.173–2.712), NLR ( HR 1.704, 95% CI 1.136–2.556), and prognostic grouping ( HR 2.285, 95% CI 1.397–3.737 for group I ; HR 2.962, 95% CI 1.719–5.102 for group II ) were independent predictors of progression‐free survival ( PFS ) in the multivariate model ( P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer‐specific survival ( CSS ) and overall survival ( OS ). Time‐dependent area under the receiver‐operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes ( P < 0.05). Conclusions Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC . The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.