Objectives: To evaluate if hematologic parameters and inflammatory markers, could predict extravesical tumor and overall survival following radical cystectomy for patients with recurrent high grade T1 or muscle invasive bladder cancer.
Patients and Methods: A total of 68 consecutive cases of radical cystectomy performed with curative intent at our institution between April 2005 and October 2011 with preoperative hematologic parameters are included in this analysis. We evaluated preoperative characteristics with uni and multivariate cox proportion hazard ratios to assist in risk stratification for overall survival. Relative risk ratios (RR) and 95% confidence intervals (CI) were created. We also identified factors associated with extravesical tumor extension with logistic regression analysis.
Results: Median overall survival was in the total cohort was 25 months. (95% CI 13-61) In multivariate analysis, neutrophil/lymphocyte ratio < 2.5 (RR 2.49; 95% CI 1.14 - 6.09) hypoalbuminemia (RR 4.96; 95% CI 2.18 - 11.67), pT3/4 (RR 7.97, 95% CI 3.16-24.83) and lymph node positive disease predicted (RR 2.62, 95% CI 1.26-5.46) overall survival. These were statistically significant for cancer specific survival as well. Both elevated neutrophil/lymphocyte ratio (RR 3.18, 95% CI 1.09 - 9.79) and hypoalbuminemia (RR 3.72, 95% CI 1.12 - 15.00) were associated with risk for extravesical disease.
Conclusions: Serum neutrophil/lymphocyte ratio and hypoalbuminemia predict overall and cancer specific survival in patients undergoing radical cystectomy for muscle invasive bladder cancer. These parameters also predict risk for extravesical disease. These could be combined with other established preoperative parameters to improve risk stratification and preoperative counseling.
Written by:
Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK. Are you the author?
Wake Forest University, Urology, Medical Center Blvd, Winston Salem, North Carolina, United States.
Reference: J Endourol. 2013 Mar 21. Epub ahead of print.
doi: 10.1089/end.2012.0606
PubMed Abstract
PMID: 23517015
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