Utilidade da Razão Neutrófilos/Linfócitos como Fator Preditor da Recorrência e da Progressão do Carcinoma da Bexiga Não Músculo Invasivo
DOI:
https://doi.org/10.24915/aup.34.3-4.46Palavras-chave:
Biomarcadores, Factores de Risco, Linfócitos, Neoplasias da Bexiga Urinária, Neutrófilos, Prognóstico, Recidiva Local de NeoplasiaResumo
Objetivos Avaliação da razão neutrófilos/linfócitos (RNL) pré-operatória, como fator preditor do risco de recorrência e progressão tumoral em doentes com carcinoma da bexiga não músculo invasivo (CBNMI).
Material e Métodos Análise retrospetiva dos doentes diagnosticados com CBNMI após serem submetidos a ressecção transuretral vesical (RTUV), entre janeiro de 2013 a dezembro de 2014. Foram excluídos os casos que não apresentavam hemograma com leucograma prévio à cirurgia e os doentes com tumores síncronos.
Foi realizada análise estatística multivariada com o software SPSS 22.0®, com as seguintes variáveis: idade, sexo, tempo até ocorrer recorrência ou progressão da doença (em meses), RNL, dimensão do tumor (≤3 ou >3cm), tumor múltiplo, histologia e grau inicial do tumor.
Resultados Foram avaliados 84 pacientes, sendo 79.8% do sexo masculino e com idade média de 69 anos. Em 67,9% dos casos o estadio tumoral inicial foi pTa e 77.4% dos tumores eram de baixo grau. Em 21.4% dos doentes o tumor era múltiplo e em 33.3% apresenta dimensões superiores a 3 cm. Observou-se recorrência tumoral em 19% dos indivíduos e progressão em 16.4%. Os pacientes com RNL>3.32 apresentaram mais frequentemente pT1 como histologia inicial do tumor (p=0.018). Em analise multivariada, a RNL>3.32 revelou estar associada a maior probabilidade de recorrência/progressão tumoral (hazard ratio [HR] = 2.94; 95% CI: 1.27–6.8; p =0. 012).
Conclusões Este estudo revela que a RNL pode ser um fator preditor de recorrência/progressão tumoral em pacientes com CBNMI, podendo ter um papel importante na prática clínica.
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Referências
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25. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of surgical oncology. 2012;19:217-224.
26. Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Annals of surgery. 2009;250:141-151.
27. Kim M, Moon KC, Choi WS, et al. Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma. World journal of urology. 2015;33:1439-1457.
28. Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013;15:323-328.
29. Ubukata H, Motohashi G, Tabuchi T, Nagata H, Konishi S, Tabuchi T. Evaluations of interferon-gamma/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients. Journal of surgical oncology. 2010;102:742-747.
30. Gondo T, Nakashima J, Ohno Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79:1085-1091.
31. Yoshida T, Kinoshita H, Yoshida K, et al. Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine. 2016;37:10067-10074.
2. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. European urology. 2017;71:96-108.
3. Ferlay J, Randi G, Bosetti C, et al. Declining mortality from bladder cancer in Europe. BJU international. 2008;101:11-19.
4. Albayrak S, Zengin K, Tanik S, et al. Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer? The Kaohsiung journal of medical sciences. 2016;32:327-333.
5. Ogihara K, Kikuchi E, Yuge K, et al. 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. Annals of surgical oncology. 2016;23:1039-1047.
6. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. European urology. 2006;49:466-465; discussion 475-467.
7. Van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. European urology. 2009;56:430-442.
8. Xylinas E, Kent M, Kluth L, et al. Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder. British journal of cancer. 2013;109:1460-1466.
9. Mbeutcha A, Shariat SF, Rieken M, et al. Prognostic significance of markers of systemic inflammatory response in patients with non-muscle-invasive bladder cancer. Urologic oncology. 2016;34:483 e417-483 e424.
10. Kluth LA, Black PC, Bochner BH, et al. Prognostic and Prediction Tools in Bladder Cancer: A Comprehensive Review of the Literature. European urology. 2015;68:238-253.
11. Wei Y, Jiang YZ, Qian WH. Prognostic role of NLR in urinary cancers: a meta-analysis. PloS one. 2014;9:e92079.
12. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surgical oncology. 2014;23:31-39.
13. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future oncology. 2010;6:149-163.
14. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144:646-674.
15. Potretzke A, Hillman L, Wong K, et al. NLR is predictive of upstaging at the time of radical cystectomy for patients with urothelial carcinoma of the bladder. Urologic oncology. 2014;32:631-636.
16. Ozyalvacli ME, Ozyalvacli G, Kocaaslan R, et al. Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2015;9:E126-131.
17. Marchioni M, Primiceri G, Ingrosso M, et al. The Clinical Use of the Neutrophil to Lymphocyte Ratio (NLR) in Urothelial Cancer: A Systematic Review. Clinical genitourinary cancer. 2016;14:473-484.
18. Viers BR, Boorjian SA, Frank I, et al. Pretreatment neutrophil-to-lymphocyte ratio is associated with advanced pathologic tumor stage and increased cancer-specific mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. European urology. 2014;66:1157-1164.
19. Budczies J, Klauschen F, Sinn BV, et al. Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PloS one. 2012;7:e51862.
20. Celik O, Akand M, Keskin MZ, Yoldas M, Ilbey YO. Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm. European review for medical and pharmacological sciences. 2016;20:652-656.
21. Favilla V, Castelli T, Urzi D, et al. Neutrophil to lymphocyte ratio, a biomarker in non-muscle invasive bladder cancer: a single-institutional longitudinal study. International braz j urol : official journal of the Brazilian Society of Urology. 2016;42:685-693.
22. Van Rhijn BW, Zuiverloon TC, Vis AN, et al. Molecular grade (FGFR3/MIB-1) and EORTC risk scores are predictive in primary non-muscle-invasive bladder cancer. European urology. 2010;58:433-441.
23. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? The Lancet. 2001;357:539-545.
24. Hashimoto T, Ohno Y, Nakashima J, Gondo T, Ohori M, Tachibana M. Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinoma. World journal of urology. 2013;31:953-958.
25. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of surgical oncology. 2012;19:217-224.
26. Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Annals of surgery. 2009;250:141-151.
27. Kim M, Moon KC, Choi WS, et al. Prognostic value of systemic inflammatory responses in patients with upper urinary tract urothelial carcinoma. World journal of urology. 2015;33:1439-1457.
28. Mallappa S, Sinha A, Gupta S, Chadwick SJ. Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013;15:323-328.
29. Ubukata H, Motohashi G, Tabuchi T, Nagata H, Konishi S, Tabuchi T. Evaluations of interferon-gamma/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients. Journal of surgical oncology. 2010;102:742-747.
30. Gondo T, Nakashima J, Ohno Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79:1085-1091.
31. Yoshida T, Kinoshita H, Yoshida K, et al. Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine. 2016;37:10067-10074.
Publicado
2017-12-16
Edição
Secção
Artigo Original
