Neutrophil-to-lymphocyte ratio as a predictor of overall survival and cancer advancement in patients undergoing radical cystectomy for bladder cancer.

Introduction: Neutrophil-to-lymphocyte ratio (NLR) has proven to be promising as a prognostic factor in many malignancies. We investigated the prognostic significance of NLR in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Material and methods: We retrospectively evaluated the data of 134 consecutive patients with BC who underwent RC between 2011 and 2017 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared between NLR subpopulations using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to identify the variables affecting OS. Results: At a median follow-up of 2.2 years, high NLR (>2.7) correlated with worse a survival outcome (p = 0.0345 in log-rank test), higher tumor stage (p = 0.0047), and higher frequency of positive lymph nodes (p = 0.0285). The univariate model showed that a high NLR (p = 0.038528), advanced pathological tumor stage (p = 0.000763), lymph node involvement (p = 0.013384), a high grade of cancer (p = 0.015611), lymphovascular invasion (LVI) (p = 0.001530), positive margins (p = 0.000890) and ureterocutaneostomy as urinary diversion (p = 0.038854) had a negative impact on OS. Tumor extending beyond the submucosa (>pT1) (hazard ratio 2.161, confidence interval 1058-4411, p = 0.0345) and lymphatic infiltration (hazard ratio 1.599, confidence interval 1028-2482, p = 0.037) have been recognized as independent risk factors of poor prognosis in multivariate Cox regression analysis. Conclusions: In our cohort, an elevated NLR is associated with worse OS and adverse histopathological findings. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

Extraperitoneal Laparoscopic Prostatectomy in a Prostate Cancer Patient Undergoing Continuous Ambulatory Peritoneal Dialysis.

Radical prostatectomy (RP) in patients on continuous ambulatory peritoneal dialysis (CAPD) is a challenging procedure. The following key points need to be considered: the peritoneal cavity integrity, adjustment of the trocar positions to the peritoneal dialysis (PD) tube location, and the oncological and functional outcomes. We present a clinical case of a patient on CAPD, incidentally diagnosed with prostate cancer (PCa) during the pre-transplant evaluation. The patient suffered from LUTS, due to bladder outlet obstruction (BOO). A transurethral bladder neck incision (TUNI), with median lobe resection, was performed. A PCa Gleason score of six (3 + 3) was found in the histopathological specimen. The primary procedure was complicated by bladder neck sclerosis and acute urinary retention (AUR), resolved by suprapubic cystostomy. After proper staging determination, the patient was qualified for laparoscopic extraperitoneal RP. The standard trocar placement was modified to align with the route of the PD tube, and Retzius' space scarring was released to allow extraperitoneal prostatectomy. There were no signs of peritoneal wall damage or dialysis tube displacement. Peritoneal dialysis was resumed after 4 weeks. Laparoscopic extraperitoneal RP should be considered as an acceptable treatment method for selected patients with localized prostate cancer, allowing CAPD resumption. To the best of our knowledge, this is the first report of retroperitoneal laparoscopic RP being used in the PD population.

Preoperative Neutrophil-lymphocyte Ratio as a Predictor of Overall Survival in Patients with Localized Renal Cell Carcinoma.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR), as an indicator of the systemic inflammatory response, predicts adverse outcomes in many malignancies. We investigated its prognostic significance in patients with non-metastatic renal cell carcinoma. MATERIALS AND METHODS: We retrospectively evaluated data of 196 consecutive non-metastatic RCC patients who underwent radical or partial nephrectomy between 2010 and 2012 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared using the log-rank test. We applied univariate and multivariate Cox regression models to evaluate the prognostic value of dichotomized NLR for OS.   Results: At a median follow up of 68 months, high NLR (? 2,69) correlated with worse survival outcome (P = .006 in log-rank test) and higher tumor stage (P = .035). Univariate and multivariate analysis identified elevated NLR (P = .039), as well as age (P = .002), high Fuhrmann grade (P = .002) and high pathologic T stage (P < .001), as significantly associated with overall survival. CONCLUSION: In our cohort, an elevated neutrophil-to-lymphocyte ratio is significantly associated with worse OS on univariate and multivariate analysis. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.