Validation of the pretreatment derived neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma

Background: The value of a combined index of neutrophil and white cell counts, named derived neutrophil-lymphocyte ratio (dNLR), has recently been proposed as a prognosticator of survival in various cancer types. We investigated the prognostic role of the dNLR in a large European cohort of patients with upper tract urothelial carcinoma (UTUC). Methods: Data from 171 non-metastatic UTUC patients, operated between 1990 and 2012 at a single tertiary academic centre, were evaluated retrospectively. Cancer-specific- (CSS) as well as overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the dNLR, multivariate proportional Cox-regression models were applied. Additionally, the influence of the dNLR on the predictive accuracy of the multivariate model was further determined by Harrell's concordance index (c-index). Results: The median follow-up period was 31 months. An increased dNLR was statistically significantly associated with shorter CSS (log-rank P = 0.004), as well as with shorter OS (log-rank P = 0.002). Multivariate analysis identified dNLR as an independent predictor for CSS (hazard ratio, HR = 1.16, 95% confidence interval, CI = 1.01-1.35, P = 0.045), as well as for OS (HR = 1.21, 95% CI = 1.09-1.34, P < 0.001). The estimated c-index of the multivariate model for OS was 0.68 without dNLR and 0.73 when dNLR was added. Conclusions: Patients with a high pretreatment dNLR could be predicted to show subsequently higher cancer-specific-as well as overall mortality after surgery for UTUC compared with those with a low pretreatment dNLR. Thus, this combined index should be considered as a potential prognostic biomarker in future.