EURURO Vol. 72 No. 6

1026 1030

David D ’Andrea a, Shahrokh F. Shariata,b,c
a Department of Urology, Medical University of Vienna, Vienna, Austria
bDepartment of Urology, University of Texas Southwestern Medical Center,
Dallas, TX, USA
cDepartment of Urology, Weill Cornell Medical College, New York-
Presbyterian Hospital, New York, NY, USA
*Corresponding author. Department of Urology, Medical University of
Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
E-mail address: (S.F. Shariat).
© 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: Low Pretreatment Neutrophil-to-Lymphocyte Ratio
Predicts for Good Outcomes in Patients Receiving
Neoadjuvant Chemotherapy Before Radical Cystectomy
for Muscle Invasive Bladder Cancer
Buisan O, Orsola A, Areal J, et al
Clin Genitourin Cancer 2017;15:145– 51
Expert's summary:
The authors evaluated the role of the pretreatment neutro-
phil-to-lymphocyte ratio (NLR) in predicting pathological
downstaging and survival in patients with muscle-invasive
bladder cancer (MIBC) undergoing neoadjuvant chemothera-
py (NAC). The study included 75 patients with MIBC, six with
clinical stage T2 and 69 with clinical stage T3. Pathological
downstaging occurred in 29 of 75 patients (38.6%). Relatively
low NLR, younger age, and clinical stage 3 were significant
predictors of downstaging. Furthermore, the NLR was an
independent predictor of progression-free, cancer-specific,
and overall survival. The authors concluded that a low NLR
may predict good outcomes after NAC in patients with MIBC.
Expert's comments:
Current guidelines recommend NAC followed by radical
cystectomy for management of MIBC . However, not all
patients with MIBC benefit fromNAC; it is therefore important
to identify those who will. One risk stratification model for
selection for NAC is the M.D. Anderson Cancer Center criteria
for preoperatively differentiating between high- and low-risk
disease. These criteria include the presence of hydroureter-
onephrosis, lymphovascular invasion, variant histology, and
clinical stage 3; patients at high risk appear most likely to
benefit fromNAC . However, inaccurate clinical tumor stage
remains a serious problem; it was found that 49% of low-risk
patients were reclassified as high risk after radical cystectomy.
In this study, Buisan et al found that relatively low NLR and
clinical stage 3 are significant predictors of downstaging.
However, this appears to be paradoxical because patients
with pT3 disease reportedly have higher NLRs than those
with pT2 . What is the reason for this apparent paradox?
Is it because clinical staging is inaccurate? Or do patients with
cT3 disease show NLR heterogeneity? In other words, do
some patients with cT3 disease have lower a NLR? Mean-
while, recent studies have developed a model for selecting
patients for NAC on the basis of genetic changes [4,5]. Howev-
er, such an approach may be difficult to implement in clinical
practice because of cost and time considerations. NLR is easily
measured and used in clinical practice. Further studies should
evaluate the clinical role of NLR in predicting patients who will
benefit from NAC and establish an easy-to-use model for
selecting patients for NAC.
Conflicts of interest: The author has nothing to disclose.
References
[1]
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[2]
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[3]
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[4]
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[5]
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Yoshio Ohn
Department of Urology, Tokyo Medical University, Tokyo, Japan
*Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku,
Shinjuku-ku, Tokyo 1600023, Japan.
E-mail address:
© 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
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