Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 1039–1047 | Cite as

The Preoperative Neutrophil-to-lymphocyte Ratio is a Novel Biomarker for Predicting Worse Clinical Outcomes in Non-muscle Invasive Bladder Cancer Patients with a Previous History of Smoking

  • Koichiro Ogihara
  • Eiji Kikuchi
  • Kazuyuki Yuge
  • Yoshinori Yanai
  • Kazuhiro Matsumoto
  • Akira Miyajima
  • Hirotaka Asakura
  • Mototsugu Oya
Urologic Oncology



We speculated that a heterogeneous population of non-muscle invasive bladder cancer (NMIBC) patients with a previous history of smoking may be more precisely stratified by a biomarker associated with tumor aggressiveness and then focused on the preoperative neutrophil-to-lymphocyte ratio (pre-NLR), which is a simple index of systemic inflammation.


Our study population comprised 605 patients initially diagnosed with NMIBC at our 3 institutions between 1995 and 2013. We analyzed the relationships between pre-NLR levels and clinical outcomes in NMIBC. A pre-NLR level of ≥2.2 was defined as elevated according to a calculation by a receiver-operating curve analysis.


In overall, a total of 296 patients (48.9 %) had pre-NLR ≥ 2.2, and the pre-NLR level was one of independent risk factors for tumor recurrence and stage progression. Among 344 patients with a previous history of smoking, 184 (53.5 %) had pre-NLR ≥ 2.2 and the pre-NLR level was one of independent risk factors for tumor recurrence and stage progression. The 5-year recurrence-free survival and progression-free survival rates in patients with pre-NLR < 2.2 were 66.3 and 97.5 %, respectively, which were significantly higher than those in their counterparts (31.7 and 90.4 %, p < 0.001). In either subgroup of patients who were current smokers (N = 175) or former smokers (N = 169), the pre-NLR level was the only independent risk factor for tumor recurrence. The pre-NLR level was not associated with tumor recurrence or stage progression in 261 nonsmoking patients.


Pre-NLR levels may be a useful marker for identifying worse clinical outcomes in NMIBC patients, particularly those with a previous history of smoking.


Tumor Recurrence MIBC Stage Progression Ideal Cutoff Predict Tumor Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



All authors certify that this study has no financial or other relationships that 3 institutions might lead to a conflict of interest.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Koichiro Ogihara
    • 1
  • Eiji Kikuchi
    • 1
  • Kazuyuki Yuge
    • 1
  • Yoshinori Yanai
    • 2
  • Kazuhiro Matsumoto
    • 1
  • Akira Miyajima
    • 1
  • Hirotaka Asakura
    • 3
  • Mototsugu Oya
    • 1
  1. 1.Department of UrologyKeio University School of MedicineTokyoJapan
  2. 2.Department of UrologySaiseikai Central HospitalTokyoJapan
  3. 3.Department of UrologySaitama Medical University HospitalSaitamaJapan

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