Introduction
Patients and methods
Patient selection and data collection
Study variables
Management and follow-up
Statistical analysis
Results
Descriptive characteristics and association with altered NLR
All patients | Normal NLR | Altered NLR |
p
| |
---|---|---|---|---|
Total, n (%) | 2274 | 846 (37.2) | 1428 (62.8) | |
Age | 0.66 | |||
Median (IQR) | 69 (61–76) | 69 (61–76) | 70 (62–76) | |
Gender, n (%) | 0.31 | |||
Male | 1527 (67.1) | 579 (68.1) | 948 (66.4) | |
Female | 747 (32.9) | 267 (31.9) | 480 (33.6) | |
Tumor stage, n (%) |
<0.001
| |||
pTa | 497 (21.8) | 199 (23.5) | 298 (20.9) | |
pTis | 48 (2.2) | 19 (2.2) | 29 (2.3) | |
pT1 | 532 (23.4) | 244 (28.8) | 288 (20.0) | |
pT2 | 441 (19.4) | 150 (17.8) | 291 (20.3) | |
pT3 | 671 (29.5) | 217 (25.7) | 454 (31.8) | |
pT4 | 85 (3.7) | 17 (2.0) | 68 (4.7) | |
Grade, n (%) | 0.22 | |||
Low | 367 (16.14) | 147 (17.3) | 220 (15.4) | |
High | 1907 (83.86) | 699 (82.7) | 1208 (84.6) | |
Lymph node status, n (%) |
0.001
| |||
pNx | 1545 (68.0) | 570 (67.4) | 975 (68.2) | |
pN0 | 545 (23.9) | 228 (27.0) | 317 (22.2) | |
pN1 | 184 (8.1) | 48 (5.6) | 136 (9.6) | |
Lymphovascular invasion, n (%) |
<0.001
| |||
Yes | 499 (21.9) | 143 (16.9) | 356 (24.9) | |
No | 1775 (78.1) | 703 (83.1) | 1072 (75.1) | |
Concomitant carcinoma in situ, n (%) | 0.17 | |||
Yes | 528 (23.2) | 183 (21.6) | 345 (24.1) | |
No | 1746 (76.8) | 663 (78.4) | 1083 (75.9) | |
Multifocality, n (%) | 0.16 | |||
Yes | 538 (23.7) | 214 (25.3) | 324 (22.7) | |
No | 1736 (76.3) | 632 (74.7) | 1104 (77.3) | |
Necrosis, n (%) |
<0.001
| |||
Yes | 516 (22.7) | 129 (15.2) | 387 (27.1) | |
No | 1758 (77.3) | 717 (84.8) | 1041 (72.9) | |
Architecture, n (%) |
0.001
| |||
Papillary | 1751 (77.0) | 684 (80.9) | 1067 (74.8) | |
Sessile | 523 (23.0) | 162 (19.2) | 361 (25.2) | |
Location | 0.67 | |||
Kidney | 1448 (63.7) | 534 (63.1) | 914 (64.0) | |
Ureter | 826 (36.3) | 312 (36.9) | 514 (36.0) |
Association of NLR with high-risk disease and lymph node metastasis
Preoperative prognostic factors | Lymph node metastasis | pT3-4 or N+ | ≥T2 or N+ | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | Univariable | Multivariable | |||||||||||||
HR | CI |
p
| HR | CI |
p
| HR | CI |
p
| HR | CI |
p
| HR | CI |
p
| HR | CI |
p
| |
NLR | 1.74 | 1.24–2.46 |
0.001
| 1.2 | 1.14–2.29 |
0.006
| 1.51 | 1.26–1.82 |
<0.001
| 1.41 | 1.16–1.72 |
0.001
| 1.58 | 1.33–1.88 |
<0.001
| 1.49 | 1.24–1.80 |
<0.001
|
Age | 0.99 | 0.98–1.00 | 0.50 | 0.99 | 0.97–1.00 | 0.26 | 1.00 | 0.99–1.01 | 0.08 | 1.00 | 0.99–1.01 | 0.33 | 1.00 | 0.99–1.01 | 0.17 | 1.00 | 0.99–1.01 | 0.68 |
Location | 0.59 | 0.42–0.83 |
0.003
| 0.56 | 0.39–0.79 |
0.001
| 0.62 | 0.51–7.47 |
<0.001
| 0.52 | 0.42–0.64 |
<0.001
| 0.89 | 0.75–1.06 | 0.21 | 0.82 | 0.68–0.99 |
0.05
|
Gender | 1.01 | 0.73–1.39 | 0.92 | 0.96 | 0.69–1.34 | 0.84 | 1.06 | 0.88–1.27 | 0.50 | 0.97 | 0.79–1.19 | 0.80 | 1.05 | 0.88–1.25 | 0.53 | 0.99 | 0.82–1.21 | 0.99 |
Architecture | 3.40 | 2.50–4.62 |
<0.001
| 3.35 | 2.52–4.72 |
<0.001
| 6.78 | 5.47–8.40 |
<0.001
| 7.11 | 5.70–8.86 |
<0.001
| 8.45 | 6.46–11.06 |
<0.001
| 8.38 | 6.40–10.99 |
<0.001
|
Accuracy without NLR |
0.67
|
0.70
|
0.66
| |||||||||||||||
Accuracy with NLR |
0.68
|
0.72
|
0.68
|
Association of NLR with cancer recurrence and cancer-specific survival
Recurrence-free survival | Cancer-specific survival | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | |||||||||
HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | |
Age | 1.01 | 1.00–1.02 | <0.001 | 1.01 | 1.00–1.02 | 0.001 | 1.02 | 1.01–1.03 | <0.001 | 1.02 | 1.01–1.03 | <0.001 |
Gender | 1.10 | 0.92–1.31 | 0.27 | 1.01 | 0.84–1.21 | 0.89 | 1.06 | 0.87–1.29 | 0.52 | 0.94 | 0.77–1.15 | 0.58 |
Stage | ||||||||||||
Ta | Ref. | |||||||||||
Tis | 2.98 | 1.30–6.83 | 0.01 | 1.61 | 0.94–7.25 | 0.066 | 3.58 | 1.44–8.88 | 0.006 | 3.37 | 1.08–10.56 | 0.03 |
T1 | 2.16 | 1.38–3.37 | <0.001 | 1.87 | 0.89–3.91 | 0.095 | 2.00 | 1.18–3.37 | 0.009 | 1.66 | 0.70–3.92 | 0.24 |
T2 | 5.01 | 3.30–7.59 | <0.001 | 3.84 | 1.86–7.92 | <0.001 | 5.54 | 3.45–8.91 | <0.001 | 4.11 | 1.79–9.45 | <0.001 |
T3 | 10.29 | 6.97–15.19 | <0.001 | 6.96 | 3.40–14.21 | <0.001 | 11.93 | 7.63–18.65 | <0.001 | 7.85 | 3.45–17.88 | <0.001 |
T4 | 39.75 | 25.36–62.29 | <0.001 | 19.94 | 9.26–42.96 | <0.001 | 46.14 | 27.74–76.75 | <0.001 | 21.30 | 8.86–51.22 | <0.001 |
Grade | 6.17 | 3.94–9.64 | <0.001 | 1.10 | 0.48–2.50 | 0.81 | 6.93 | 4.14–11.60 | <0.001 | 1.17 | 0.45–3.03 | 0.73 |
Lymphovascular invasion | 3.13 | 2.64–3.71 | <0.001 | 1.24 | 1.02–1.52 | 0.029 | 3.39 | 2.81–4.09 | <0.001 | 1.35 | 1.08–1.67 | 0.006 |
Architecture | 3.30 | 2.78–3.91 | <0.001 | 1.37 | 1.12–1.66 | 0.002 | 3.46 | 2.87–4.17 | <0.001 | 1.36 | 1.10–1.69 | 0.004 |
Carcinoma in situ | 1.67 | 1.39–2.00 | <0.001 | 1.23 | 1.01–1.50 | 0.035 | 1.57 | 1.28–1.92 | <0.001 | 1.08 | 0.87–1.35 | 0.46 |
Necrosis | 2.22 | 1.86–2.64 | <0.001 | 0.98 | 0.81–1.19 | 0.90 | 2.25 | 1.86–2.74 | <0.001 | 1.00 | 0.81–1.23 | 0.98 |
Multifocality | 1.31 | 1.08–1.58 | 0.004 | 0.91 | 0.74–1.11 | 0.36 | 1.33 | 1.08–1.64 | 0.006 | 0.95 | 0.76–1.70 | 0.66 |
Location | 1.11 | 0.94–1.32 | 0.19 | 1.31 | 1.09–1.57 | 0.003 | 1.16 | 0.96–1.40 | 0.11 | 1.39 | 1.14–1.70 | <0.001 |
Lymph node metastases Nx | Ref. | |||||||||||
N0 | 1.13 | 0.92–1.40 | 0.22 | 0.91 | 0.73–1.12 | 0.39 | 0.99 | 0.77–1.26 | 0.94 | 0.77 | 0.60–0.98 | 0.04 |
N1 | 5.26 | 4.25–6.51 | <0.001 | 2.10 | 1.64–2.68 | <0.001 | 5.24 | 4.16–6.59 | <0.001 | 1.96 | 1.51–2.56 | <0.001 |
NLR | 1.30 | 1.09–1.56 | 0.003 | 1.05 | 0.87–1.26 | 0.59 | 1.36 | 1.11–1.66 | 0.002 | 1.07 | 0.87–1.31 | 0.48 |
Patient subgroups | Recurrence-free survival | Cancer-specific survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | |||||||||
HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | |
pTa-4 high grade | 1.28 | 1.07–1.54 | 0.007 | 1.05 | 0.87–1.26 | 0.65 | 1.34 | 1.09–1.64 | 0.005 | 1.06 | 0.87–1.31 | 0.54 |
pTa-2 pN0/Nx | 0.98 | 0.74–1.31 | 0.91 | 0.85 | 0.63–1.13 | 0.27 | 1.02 | 0.73–1.41 | 0.92 | 0.86 | 0.62–1.20 | 0.38 |
pT1-3 pN0/Nx | 1.07 | 0.87–1.33 | 0.51 | 0.92 | 0.74–1.14 | 0.43 | 1.20 | 0.94–1.52 | 0.14 | 1.01 | 0.79–1.29 | 0.92 |
pT3/pT4 N0/Nx | 1.16 | 0.87–1.53 | 0.31 | 1.12 | 0.84–1.49 | 0.44 | 1.26 | 0.92–1.72 | 0.1 | 1.20 | 0.87–1.64 | 0.27 |
pT2-4 pN0/Nx | 1.08 | 0.86–1.36 | 0.51 | 1.01 | 0.80–1.28 | 0.90 | 1.11 | 0.86–1.43 | 0.40 | 1.03 | 0.80–1.33 | 0.82 |
pTa-4 pN0 | 1.30 | 0.90–1.89 | 0.16 | 1.17 | 0.79–1.74 | 0.42 | 1.69 | 1.07–2.67 | 0.02 | 1.47 | 0.91–2.38 | 0.1 |
pTa-4 pN1 | 1.54 | 0.99–2.39 | 0.05 | 1.30 | 0.81–2.09 | 0.27 | 1.39 | 0.88–2.19 | 0.15 | 1.20 | 0.73–1.98 | 0.46 |
Association of NLR with cancer recurrence and cancer-specific survival after RNU with lymphadenectomy
Recurrence-free survival | Cancer-specific survival | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | |||||||||
HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | HR | 95 % CI |
p value | |
Age | 1.01 | 1.00–1.02 | 0.01 | 1.01 | 0.99–1.02 | 0.06 | 1.02 | 1.00–1.03 | <0.001 | 1.02 | 1.00–1.03 |
0.005
|
Gender | 1.23 | 0.95–1.60 | 0.11 | 1.14 | 0.86–1.49 | 0.34 | 1.06 | 0.79–1.43 | 0.66 | 0.93 | 0.68–1.27 | 0.67 |
Stage | ||||||||||||
Ta | Ref. | |||||||||||
Tis | 1.06 | 0.12–8.87 | 0.95 | 1.47 | 0.13–16.43 | 0.75 | 1.52 | 0.17–13.06 | 0.70 | 3.81 | 0.23–61.67 | 0.34 |
T1 | 2.34 | 0.93–5.90 | 0.07 | 2.76 | 0.63–11.98 | 0.17 | 1.41 | 0.47–4.23 | 0.53 | 2.63 | 0.33–20.90 | 0.36 |
T2 | 5.24 | 2.23–12.31 | <0.001 | 5.37 | 1.28–22.42 |
0.02
| 4.34 | 1.69–11.13 | 0.002 | 6.64 | 0.89–49.14 | 0.06 |
T3 | 10.22 | 4.50–23.17 | <0.001 | 8.68 | 2.12–35.50 |
0.003
| 10.03 | 4.09–24.61 | <0.001 | 12.34 | 1.70–84.46 |
0.01
|
T4 | 32.13 | 13.57–76.07 | <0.001 | 19.95 | 4.66–85.29 |
<0.001
| 33.0 | 12.90–84.60 | <0.001 | 25.92 | 3.45–194.75 |
0.002
|
Grade | 6.76 | 2.51–18.18 | <0.001 | 0.73 | 0.13–4.04 | 0.72 | 5.30 | 1.97–14.29 | <0.001 | 0.36 | 0.04–3.26 | 0.36 |
Lymphovascular invasion | 2.45 | 1.90–3.16 | <0.001 | 0.88 | 0.66–1.18 | 0.42 | 2.92 | 2.19–3.88 | <0.001 | 1.05 | 0.76–1.45 | 0.74 |
Architecture | 3.05 | 2.36–3.94 | <0.001 | 1.48 | 1.10–2.00 |
0.009
| 3.39 | 2.55–4.52 | <0.001 | 1.58 | 1.13–2.20 |
0.007
|
Carcinoma in situ | 1.38 | 1.06–1.79 | 0.01 | 1.17 | 0.88–1.56 | 0.26 | 1.31 | 0.97–1.77 | 0.07 | 0.94 | 0.68–1.31 | 0.74 |
Necrosis | 1.97 | 1.52–2.54 | <0.001 | 1.02 | 0.77–1.35 | 0.85 | 1.97 | 1.48–2.62 | <0.001 | 1.02 | 0.75–1.39 | 0.86 |
Multifocality | 1.12 | 0.84–1.48 | 0.42 | 0.82 | 0.60–1.11 | 0.20 | 1.32 | 0.97–1.80 | 0.07 | 0.99 | 0.71–1.39 | 0.98 |
Location | 0.97 | 0.74–1.27 | 0.87 | 1.23 | 0.93–1.64 | 0.13 | 1.02 | 0.76–1.37 | 0.87 | 1.31 | 0.95–1.79 | 0.09 |
Lymph node metastases | 4.61 | 3.57–5.96 | <0.001 | 2.62 | 1.95–3.52 |
<0.001
| 5.23 | 3.93–6.97 | <0.001 | 2.75 | 1.98–3.83 |
<0.001
|
NLR | 1.63 | 1.23–2.16 | <0.001 | 1.29 | 0.96–1.73 | 0.08 | 1.79 | 1.30–2.47 | <0.001 | 1.43 | 1.02–2.00 |
0.03
|