Media reporting of ProtecT: a disconnect in information dissemination?

BACKGROUND: Given the central role of the media in disseminating information to the public, we analyzed news coverage of the recent publication from ProtecT to assess views on treatment, the level of detail presented and degree of bias. METHODS: We applied a predefined search strategy to identify all news articles reporting on ProtecT within 30 days of its publication. Articles were independently assessed by two urologists and two lay persons using five-point Likert scales. Descriptive statistics and analysis of variance were used. RESULTS: Of 33 unique articles identified, 20 (61%) conveyed negative views on definitive treatment for localized prostate cancer (PCa), while 29 (88%) expressed favorable views of active surveillance/monitoring (AM). Nevertheless, fewer than half of the articles described what AM entails (n=15; 46%) or the rate of treatment in the AM arm (n=12; 36%). Moreover, while 32 (97%) articles highlighted the absence of a difference in cancer-specific mortality at 10 years, only 17 (52%) mentioned the need for longer follow-up. A total of 17 (52%) articles had a notable degree of perceived bias (⩾4/5 on Likert scale), with shorter articles (P=0.02), articles covering few content areas (P=0.03) and articles that did not detail what AM entails (P=0.003) containing significantly increased bias. CONCLUSIONS: The majority of news articles regarding ProtecT presented an adverse view of definitive treatment for localized PCa relative to AM, but failed to highlight key nuances of the trial. Healthcare professionals and the lay public should be cautious in acquiring medical news through the general media. Additionally, the urologic community must continue to improve the quality of disseminated information, for example, through proactively engaging with the media, through social media and/or through participation in continuing education lecture series, so as to guide the knowledge translation process, especially upon publication of such potentially influential studies.

Pre-treatment neutrophil-to-lymphocyte ratio as predictor of adverse outcomes in patients undergoing radical cystectomy for urothelial carcinoma of the bladder.

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.