Urologic Oncology: Seminars and Original Investigations ] (2015) ∎∎∎–∎∎∎
Letter to the Editor
Neutrophil-to-lymphocyte ratio predicts
progression and recurrence of non–muscle-
invasive bladder cancer
To the Editor:
Neutrophil-to-lymphocyte ratio predicts progression and
recurrence of non–muscle-invasive bladder cancer study by
Mano et al., analyzing patients' data to evaluate the
neutrophil-to-lymphocyte ratio (NLR) predictive value,
determined that NLR is an independent predictor of disease
progression and recurrence in patients with non–muscle-
invasive bladder cancer (NMIBC) without hematological
malignancies. Inflammation with a direct effect on NLR is
frequently associated with stages of tumor development
including initiation, promotion, malignant conversion, inva-
sion, and metastasis [1]. Cancerous tissue, besides leading
to systemic inflammatory response, may also lead to a
localized, more generalized, and nonspecific inflammatory
response owing to destruction and disruption caused by the
physical effects of tumor and chemocytokine release.
Elevated NLR is evident in groups with more advanced
or aggressive disease with increased tumor stage, nodal
stage, and metastatic lesions [2]. NLR threshold value o2.5
and Z2.5 and tumor size could be independent prognostic
factors in patients with bladder cancer (BC) who are treated
with radical cystectomy [3]. NLR levels of Z2.5 reflect
tumor aggressiveness and predict the local pathologic
situation and act as a biomarker for BC tumor invasiveness.
Presence of stromal desmoplasia in the pathology and
related inflammatory response also aid in determining tumor
http://dx.doi.org/10.1016/j.urolonc.2015.05.017
1078-1439/r 2015 Elsevier Inc. All rights reserved.
invasion [4]. For a strong host systemic inflammatory
response, advanced tumor stage, grade, and aggressiveness
are necessary. Thus, NLR per se cannot determine NMIBC
progression and recurrence. Moreover, some conditions,
hematological malignancies, and other illnesses have an
effect on the inflammation status, making NLR a frail
biomarker in the long-winding battle against BC.
In NMIBC tumors, NLR alone cannot be used currently
as a prognostic marker; yet, further prospective studies with
large series of patients with BC with definite pathologies
and without comorbidity factors are required.
Mehmet Kaynar, M.D.
Serdar Goktas, M.D.
Department of Urology, Faculty of Medicine
Selcuk University, Konya, Turkey
References
[1] Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and
cancer. Cell 2010;140:883–99.
[2] Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC,
Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte
ratio: experience in patients with cancer. Crit Rev Oncol Hematol
2013;88:218–30.
[3] Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K,
et al. Prognostic value of neutrophil-to-lymphocyte ratio and establish-
ment of novel preoperative risk stratification model in bladder cancer
patients treated with radical cystectomy. Urology 2012;79:1085–91.
[4] Kaynar M, Yıldırım ME, Badem H, et al. Bladder cancer invasion
predictability based on preoperative neutrophil-lymphocyte ratio.
Tumour Biol 2014;35:6601–5.