A high pretreatment neutrophil-to-lymphocyte ratio (NLR) is associated with worse outcomes in patients with muscle-invasive bladder cancer (MIBC), according to a study published in Clinical Genitourinary Cancer

Researchers found that a high pretreatment NLR was associated with lower odds of complete response (CR) and partial response (PR) after neoadjuvant chemotherapy (NAC). The researchers also found that adding NLR to predictive models could improve their accuracy. 

The researchers conducted a retrospective analysis of 404 patients with MIBC who  were treated with NAC or induction chemotherapy (for cN-positive patients), followed by open radical cystectomy (RC).

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Overall, 41.8% of patients had a high pretreatment NLR. An elevated NLR was associated with significantly higher rates of adverse pathologic features, including advanced tumor stage (P <.001), positive soft tissue surgical margins (P =.022), and lymph node metastases (P =.025).

In a multivariable analysis, a high NLR was significantly associated with lower odds of achieving a CR (odds ratio [OR], 0.26; 95% CI, 0.14-0.46; P <.001) or PR (OR, 0.36; 95% CI, 0.23-0.56; P <.001). 

However, there was no significant association between NLR and lymph node metastasis at RC (OR, 1.44; 95% CI, 0.88-2.35; P =.14) or lymph node response (OR, 1.56; 95% CI, 0.76-3.21; P =.2).

In a multivariable analysis adjusted for pretreatment variables, a high NLR was associated with inferior recurrence-free survival (hazard ratio [HR], 1.54; 95% CI, 1.09-2.17; P =.015), cancer-specific survival (HR, 1.58; 95% CI, 1.06-2.37; P =.026), and overall survival (HR, 1.47; 95% CI, 1.04-2.09; P =.030).

However, in a multivariable analysis adjusted for postoperative variables, there was no significant association between NLR and survival outcomes.

The researchers also found that adding NLR to predictive models increased the models’ accuracy for predictions of CR and PR but not lymph node involvement, lymph node response, or survival outcomes. 

“In combination with other inflammatory markers, NLR should be included in future studies and predictive models, especially in the era of new systemic therapies,” the researchers concluded. “Being inexpensive and broadly available, NLR holds potential in identifying patients who are at risk of poor response to NAC and might benefit from RC alone or other treatment strategies.”  

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


von Deimling M, Schuettfort VM, D’Andrea D, et al. Predictive and prognostic role of the neutrophil-to-lymphocyte ratio in muscle invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy. Clin Genitourin Cancer. Published online January 25, 2023. doi:10.1016/j.clgc.2023.01.008