Session Item

The role of inflammation in the development of bladder cancer is now established. We wanted to evaluate the significance of inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and neutrophil count in patients with localized muscle-invasive bladder cancer (MIBC) treated with chemoradiation (CRT).

Patients treated between 1996 and 2019 with curative CRT for non-metastatic MIBC were retrospectively included. Clinical and treatment characteristics, baseline biological data (including NLR, and neutrophils counts(PNN)), acute and late toxicities were recorded. Local and metastatic recurrences, overall survival (OS) and progression-free survival (PFS) were evaluated. We tested the association between NLR, PNN, and survival outcomes. We used median values as cut-off for statistical analysis.

Two hundred and four patients were included. Median age at diagnosis was 79.0 years [55.0 – 94.0] and median follow-up was 41.3 months [1.0 – 243.5]. Local and metastatic recurrences occurred in 29 patients (17%) and 60 patients (36%), respectively. The 4-year OS and PFS rates were 46% [37.5% – 54.4%] and 28.9% [21.7% – 36.5%], respectively. There was significantly more hydronephrosis in the high NLR (>2.6) group (41% vs 24%, p=0.02). Median OS was significantly lower in patients with NLR>2.6 compared to patients with NLR≤2.6 (24.1 months [18.6 – 40.6]  vs 56.8 months [42.7 – 96.8], p=0.006) (Fig 1). Median OS was significantly lower in patients with PNN > 4000/mm³ compared to patients with PNN≤4000/mm³(24.1 months [14.1 – 30.5] vs 70.1 months [52.4 –], p<0.001). By univariate analysis, T3-T4 stage (HR=1.97, 95%CI [1.22–3.17]; p=0.005), hydronephrosis (HR=1.69, 95%CI [1.11 – 2.58], p=0.02), PNN >4000/mm³ (HR=2.74, 95%CI [1.77 – 4.24], p<0.001), and NLR>2.6 (HR=1.77, 95%CI [1.17 – 2.67], p=0.007) were significantly associated with shorter OS. By multivariate analysis, only PNN>4000/mm³ was significantly associated with shorter OS (HR=2.95, 95%CI [1.67 – 5.21], p<0.001). Median PFS was significantly lower in patients with NLR>2.6 compared to patients with NLR<2.6 (13.1 months [9.6 – 21.8] vs 26.7 months [15.9 – 44.7], p=0.03) (Fig 2). Median PFS was significantly lower in patients with PNN > 4000/mm³ compared to patients with  PNN ≤ 4000 (12.7 months [8.0 – 19.0] vs 38.8 months [18.6 – 96.8], p<0.001). By univariate analysis, T3-T4 stage (HR=1.95, 95%CI [1.27 – 3.01], p=0.002), hydronephrosis (HR=1.83, 95%CI [1.27 – 2.65], p=0.001), PNN >4000/mm³ (HR=2.10, 95%CI [1.45 – 3.04], p<0.001) and NLR >2.6 (HR=1.49, 95%CI [1.04 – 2.13], p=0.03) were significantly associated with shorter PFS. By multivariate analysis, only  PNN>4000/ mm³ was significantly associated with shorter PFS (HR=1.79, 95%CI [1.12 – 2.85], p=0.015).

NLR was not an associated with survival outcomes, but rather with hydronephrosis. However, an elevated neutrophil count at baseline (>4000/mm3) was associated with worse OS and PFS. Prospective studies are necessary to validate these findings.