The Lymphovascular Invasion and Neutrophil-to-lymphocyte Ratio Increase the Prognostic Value of the Basal Model in UTUC Patients after Radical Nephroureterectomy

Abstract

Abstract Objective To determine the prognostic value of lymphovascular invasion (LVI), neutrophil-to-lymphocyte ratio (NLR) and their combination for predicting oncological outcomes in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). Materials and methods Data from 581 UTUC patients who underwent RNU at our institution from May 2003 to June 2019 were retrospectively analyzed. The predictive value on the endpoints of interest, including overall survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MFS), was assessed by Kaplan‒Meier curves and the Cox proportional hazard model. The receiver operating characteristic (ROC) curve was computed to evaluate the predictive ability. Results Patients in the LVI-positive group or NLR-high group had a significantly worse OS, CSS and MFS than those in the LVI-negative group or NLR-low group. LVI-positive and NLR-high coexistence was an independent risk factor for OS, CSS and MFS in multivariate analyses (HR 2.28, 95% CI 1.52–3.44; HR 2.56, 95% CI 1.63–4.01; HR 1.83, 95% CI 1.09–3.06, respectively). Furthermore, adding LVI and NLR to the basal model, consisting of tumor stage, grade and lymph node metastasis, improved the ability to predict the survival outcomes of UTUC patients in ROC analysis. Conclusion LVI, NLR and their combination were all independent risk factors for OS, CSS and MFS in UTUC patients after RNU. Adding LVI and NLR into the basal model enhanced the prognostic prediction ability throughout the follow-up period. It might be a feasible and promising tool for risk stratification and individualized treatment.