PD15-05: Prognostic value of early dynamic change of neutrophil to lymphocyte ratio (NLR) in patients with upper-tract urothelial carcinoma (UTUC) treated with nephroureterectomy

Natalie Kowshiga George*, Yasmin Abu-Ghanem, Ko Ko Zayar Toe, Akinlolu Oluwole-Ojo, Elsie Mensah, Ramesh Thurairaja, Shamim Khan, Sachin Malde, Rajesh Nair, London, United Kingdom

Introduction: Previous studies have shown that high pre-treatment neutrophil-lymphocyte ratio (NLR) is associated with worse cancer-specific mortality for upper-tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). However, whether the dynamic change of these markers can predict the outcome in various malignancies remained controversial. This study aims to examine whether the delta-NLR is an independent prognostic factor for overall survival in UTUC patients following RNU.

Methods: A total of 87 patients who underwent NU for UTUC in a single institution between November 2017 and February 2020 were analysed retrospectively. Clinicopathological features, preoperative NLR and postoperative NLR were collected. Prognostic factors were evaluated by univariate and multivariate analysis. Delta-NLR was defined as the postoperative minus the preoperative value. Two groups were created accordingly: delta-NLR = 0, delta-NLR < 0.

Results: Final cohort included 87 patients, with a median age of 71 (IQR:64-75) and a median follow up of 24 months. The median value of pre-NLR was 2.75 (1.9–3.9) and post-NLR was 1.3 (0.9–1.9). Risk factors for overall survival included tumour size (Hazard ratio [HR]:-1.2, p<0.05), microvascular invasion (HR:6.9, p<0.005), clinical stage (HR:4.1, p<0.005). In regards to NLR, both pre-operative (HR:0.97, P<0.05) and post-operative NLR (HR:0.46, p<0.001) was found associated with prognosis. This association was supported by other markers that were found as significant predictive markers as well including pre-and post-operative haemoglobin (HB), (HR:0.21, HR:0.1, P<0.05) and white blood cells (WBC), (HR:-1.4,HR:0.14, P<0.001). However, surprisingly, the dynamic change in NLR did not seem to be associated with prognosis (P=0.18).

Conclusions: The current study supports the prognostic value of NLR in patients with UTUC. However, we found that immediate, perioperative changes in NLR levels may not necessarily be a useful as a prognostic factor in selecting appropriate treatment strategies for UTUC. Since delta-NLR is reflecting the balance between systemic inflammatory response and immune response, it could be that the early dynamics may reflect on immediate recovery rather than long term cancer control.

Source of Funding: N/A