Clinical Significance Of Preoperative Neutrophil-lymphocyte Ratio For Intravesical Recurrence After Radical Nephroureterectomy For Upper Tract Urothelial Carcinoma

ObjectiveA number of years of researches have shown that preoperative inflammatory markers in the peripheral blood are associated with recurrence and prognosis of a variety of malignancies,and neutrophil-lymphocyte ratio(NLR)is representative of inflammatory markers associated with recurrence and poor prognosis.The aim of this study was to determine the relationship between neutrophil-lymphocyte ratio and the intravesical recurrence in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma(UTUC)and to guide postoperative bladder instillation and follow-up.MethodsThe complete data of patients with renal pelvic carcinoma or ureteral carcinoma who underwent retroperitoneoscopic radical nephroureterectomy of upper urinary tract urothelial carcinoma from December 1,2011 to December 31,2016 in the Second Hospital of Tianjin Medical University were retrospectively analyzed,including demographic data,preoperative blood routine data(calculated neutrophil to lymphocyte ratio),preoperative urine cytology test results,postoperative pathological data(tumor location,tumor number,surgical margin,primary tumor staging,tumor grade,lymph node Infiltration),,and the first occurrence of intravesical recurrence after surgery.Univariate and multivariate regression models were used to evaluate the relationship between preoperative NLR and intravesical recurrence.All data were analyzed using SPSS software.ResultsAmong the 117 patients who met the inclusion criteria,32 patients had intravesical recurrence(IVR)at a median follow-up period of 23.5 months(4 months to 34 months).The preoperative NLR cut-off point was determined to be 3.8 based on the receiver operating characteristic curve(ROC curve),?3.8 was defined as high NLR(n=23),<3.8 was low NLR(n=94),High preoperative NLR significantly increased lymph node involvement risk(P=0.013)and IVR risk(P=0.004)compared with low preoperative NLR;preoperative high NLR(P=0.016))and tumor multifocal(P=0.007)significantly increased the risk of intravesical recurrence.In a multivariate regression model analysis,high preoperative NLR(HR=2.49;P=0.015)and multifocal lesions(HR=2.96;P=0.024)were independent risk factor of intravesical recurrence.ConclusionNLR is a risk factor for predicting intravesical recurrence after radical nephroureterectomy(RNU).It may be an effective prognostic indicator and can be used to guide the treatment and follow-up after RNU.