ABSTRACT
BACKGROUND: An elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor outcome in various tumours. Its prognostic utility in patients with urothelial carcinoma of the bladder (UCB) undergoing radical cystectomy (RC) is yet to be fully elucidated. METHODS: A cohort of patients undergoing RC for UCB in a tertiary referral centre between 1992 and 2012 was analysed. Neutrophil-to-lymphocyte ratio was computed using complete blood counts performed pre-RC, or before neo-adjuvant chemotherapy where applicable. Time-dependent receiver operating characteristic curves were used to determine the optimal cutoff point for predicting recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). The predictive ability of NLR was assessed using Kaplan-Meier analyses and multivariable Cox proportional hazards models. The likelihood-ratio test was used to determine whether multivariable models were improved by including NLR. RESULTS: The cohort included 424 patients followed for a median of 58.4 months. An NLR of 3 was determined as the optimal cutoff value. Patients with an NLR⩾3.0 had significantly worse survival outcomes (5y-RFS: 53% vs 64%, log-rank P=0.013; 5y-CSS: 57% vs 75%, log-rank P<0.001; 5y-OS: 43% vs 64%, log-rank P<0.001). After adjusting for disease-specific predictors, an NLR ⩾3.0 was significantly associated with worse RFS (HR=1.49; 95% CI=1.12-2.0, P=0.007), CSS (HR=1.88; 95% CI=1.39-2.54, P<0.001) and OS (average HR=1.67; 95% CI=1.17-2.39, P=0.005). The likelihood-ratio test confirmed that prognostic models were improved by including NLR. CONCLUSIONS: Neutrophil-to-lymphocyte ratio is an inexpensive prognostic biomarker for patients undergoing RC for UCB. It offers pre-treatment prognostic value in addition to established prognosticators and may be helpful in guiding treatment decisions.
Subject(s)
Carcinoma, Transitional Cell/immunology , Lymphocytes/immunology , Neutrophils/immunology , Urinary Bladder Neoplasms/immunology , Aged , Carcinoma, Transitional Cell/mortality , Carcinoma, Transitional Cell/surgery , Cystectomy , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Lymphocyte Count , Male , Middle Aged , Preoperative Period , Prognosis , Proportional Hazards Models , ROC Curve , Retrospective Studies , Treatment Outcome , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/surgeryABSTRACT
OBJECTIVE: To evaluate our experience of laparoscopic cholecystectomies at the Aga Khan Hospital, Nairobi over a three-year period from the inception of the technique, and to assess its value and advantages to the patients. DESIGN: A prospective case series study. SETTING: The Aga Khan Hospital, Nairobi. PATIENTS: One hundred and thirty five cases operated from February 1996 to April 1999. All patients were subjected to the American method of laparoscopic cholecystectomy, which is described in detail in this paper. MAIN OUTCOME MEASURES: Clinical presentation, age and sex demographics, average hospital stay, intraoperative and postoperative complications and outcome. RESULTS: There was a female preponderance with a female to male ratio of 5:1. Mean age was forty nine years. Majority of patients suffered from chronic cholecystitis. The conversion rate to an open procedure was five per cent. There were two cases of significant bile leakage which required laparotomy. No mortality was reported in this series. CONCLUSION: This technique was found to have distinct advantages such as shorter hospital stay, lesser postoperative pain and very good cosmesis. It is a safe procedure if performed by a well trained surgeon.
