Category: Clinical Oncology: Outcomes & Complications

MP23-10 - Preoperative lymphocyte-to-monocyte ratio as an indicator of intravesical recurrence in non-muscle invasive bladder cancer

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Several systemic inflammatory response biomarkers have been reported to be associated with poor outcome of various cancers. We presented lymphocyte-to-monocyte ratio (LMR) as an indicator of poor overall survival in muscle invasive bladder cancer. Non-muscle invasive bladder cancer (NMIBC) has a high recurrence rate. We hypothesized that low LMR was associated with recurrence and progression of bladder cancer. The aim of this study was to assess the potential value of the low LMR as a prognostic factor in NMIBC.


Methods :

Records of 423 patients who underwent transurethral resection of bladder tumor (TURBT) at Nagoya Daini Red Cross Hospital between 2012 and 2015 were analyzed retrospectively. However, those with T2 or higher-stage cancer, pathological findings other than urothelial carcinoma and who received adjuvant radiotherapy were excluded. Accordingly, we calculated the LMR just before TURBT in 335 patients. During this follow-up period, we had not treated them with immediate intravesical chemotherapy. Univariate and multivariable cox proportional hazards regression analyses were used to identify factors influencing recurrence-free survival (RFS) and progression-free survival (PFS). In this analysis, covariates included age, sex, body mass index, pathological T stage, tumor grade, multiple or single lesion, presence of CIS, tumor size, recurrence history of bladder cancer, and LMR.


Results :

The median age was 73 years (52–88), with a median follow-up period of 30 months (3–60). During the follow-up period, recurrence of bladder cancer occurred in 129 patients (38.5%) and progression occurred in 22 patients (6.6%). The mean LMR before TURBT was 5.05 (0.85–14.4). An LMR of 5.2 was identified as the optimal cutoff value according to the receiver-operating curve. In 175 of the 335 patients, LMR was <5.2. Comparison using the Kaplan-Meier method showed that patients with an LMR of <5.2 had poor RFS (P = 0.0007). At only short period (9 months) from TURBT, there was no significant  difference in two groups (P=0.0647). Univariate and multivariate analyses confirmed that lower LMR and recurrence history were independent poor predictors of RFS in patients with NMIBC. A lower LMR (hazard ratio [HR], 3.83; 95% confidence interval [CI], 1.94–7.25; P = 0.001) and recurrence history (HR, 3.17; 95% CI, 1.80–5.68; P = 0.0192) were associated with a higher risk of poor RFS.


Conclusions :

An LMR of <5.2 may be a predictor of poor RFS in patients with NMIBC. LMR can be measured easily. It can be considered to use LMR as a factor in determining the follow up strategy. Further investigation is needed to beter understanding the impact of LMR.

Yushi Yamauchi

RESIDENT
NAGOYA DAINI RED CROSS HOSPITAL
Nagoya, Aichi, Japan

I am Yushi Yamauchi, Japanese Urologist in Nagoya Daini Red Cross Hospital.
My abstruct is Preoperative lymphocyte-to-monocyte ratio as an indicator of intravesical recurrence in non-muscle invasive bladder cancer.

Kyosuke Hattori

Nagoya, Aichi, Japan

Ryo Ishida

Nagoya, Aichi, Japan

Toshinori Nishikimi

Nagoya, Aichi, Japan

Hiroshi Yamada

Nagoya, Aichi, Japan

Hiroaki Kobayashi

Nagoya, Aichi, Japan