Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy

Matteo Ferro; Dragoş-Florin Babă; Ottavio de Cobelli; Gennaro Musi; Giuseppe Lucarelli; Daniela Terracciano; Angelo Porreca; Gian Maria Busetto; Francesco Del Giudice; Francesco Soria; Paolo Gontero; Francesco Cantiello; Rocco Damiano; Papalia Rocco; Roberto Mario Scarpa; Abdal Rahman Abu Farhan; Riccardo Autorino; Antonio Brescia; Michele Marchioni; Andrea Mari; Andrea Minervini; Nicola Longo; Francesco Chiancone; Sisto Perdona'; Biagio Barone; Pietro De Placido; Michele Catellani; Danilo Bottero; Pasquale Ditonno; Michele Battaglia; Stefania Zamboni; Alessandro Antonelli; Francesco Greco; Giorgio Ivan Russo; Salvatore Smelzo; Rodolfo Hurle; Nicolae Crisan; Matteo Manfredi; Francesco Porpiglia; Felice Crocetto; Carlo Buonerba; Alina Danilesco; Mihai Dorin Vartolomei

doi:10.2144/fsoa-2021-0008

Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy

Future Sci OA. 2021 Apr 20;7(7):FSO709. doi: 10.2144/fsoa-2021-0008. eCollection 2021 Aug.

Authors

Matteo Ferro¹, Dragoş-Florin Babă^{2

3}, Ottavio de Cobelli^{1

4}, Gennaro Musi^{1

4}, Giuseppe Lucarelli⁵, Daniela Terracciano⁶, Angelo Porreca⁷, Gian Maria Busetto⁸, Francesco Del Giudice⁸, Francesco Soria⁹, Paolo Gontero⁹, Francesco Cantiello¹⁰, Rocco Damiano¹⁰, Papalia Rocco¹¹, Roberto Mario Scarpa¹¹, Abdal Rahman Abu Farhan¹⁰, Riccardo Autorino¹², Antonio Brescia¹, Michele Marchioni¹³, Andrea Mari¹⁴, Andrea Minervini¹⁴, Nicola Longo¹⁵, Francesco Chiancone¹⁶, Sisto Perdona'¹⁷, Biagio Barone¹⁵, Pietro De Placido¹⁸, Michele Catellani¹, Danilo Bottero¹, Pasquale Ditonno⁵, Michele Battaglia⁵, Stefania Zamboni¹⁹, Alessandro Antonelli^{19

20}, Francesco Greco²¹, Giorgio Ivan Russo²², Salvatore Smelzo²³, Rodolfo Hurle²⁴, Nicolae Crisan²⁵, Matteo Manfredi²⁶, Francesco Porpiglia²⁶, Felice Crocetto¹⁵, Carlo Buonerba^{27

28}, Alina Danilesco², Mihai Dorin Vartolomei^{1

2

29}

Affiliations

¹ Department of Urology, European Institute of Oncology, IRCSS, Milan, Italy.
² Department of Cell & Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania.
³ Cardiovascular Disease and Transplant Institute, Department of Urology, Targu Mures, Romania.
⁴ Department of Oncology & Haematology-Oncology, University of Milan, Milan, Italy.
⁵ Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy.
⁶ Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
⁷ Department of Oncological Urology, Veneto Institute of Oncology IOV, IRCSS, Padua, Italy.
⁸ Department of Urology, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
⁹ Division of Urology, Department of Surgical Sciences, AOU Citta´ della Salute e della Scienza, Turin School of Medicine, Turin, Italy.
¹⁰ Department of Urology, University of Catanzaro, Università 'Magna Græcia', Catanzaro, Italy.
¹¹ Department of Urology, Policlinic University Campus of Bio-Medicine of Rome, Rome, Italy.
¹² Division of Urology, Virginia Commonwealth University Health System, Richmond, VA 23298, USA.
¹³ Department of Medical, Oral & Biotechnological Sciences, Gabriele d'Annunzio University of Chieti & Pescara, Chieti, Italy.
¹⁴ Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy.
¹⁵ Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy.
¹⁶ Urology Unit, AORN Cardarelli, Naples, Italy.
¹⁷ Division of Urology, National Cancer Institute IRCCS Pascale Foundation, Naples, Italy.
¹⁸ Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, Italy.
¹⁹ Department of Urology, ASST Spedali Civili di Brescia, Brescia, Italy.
²⁰ Department of Urology, University of Verona, Verona, Italy.
²¹ Clinic of Urology, Centro Salute Uomo, Bergamo, Italy.
²² Department of Urology, University of Catania, Catania, Italy.
²³ Department of Urology, San Raffaele Turro Hospital, San Raffaele University, Milan, Italy.
²⁴ Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.
²⁵ Department of Urology, University of Medicine & Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania.
²⁶ Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy.
²⁷ Department of Oncology & Hematology, Regional Reference Center for Rare Tumors, University of Naples Federico II, Naples, Italy.
²⁸ National Reference Center for Environmental Health, Zoo-prophylactic Institute of Southern Italy, Portici, Italy.
²⁹ Department of Urology, Medical University of Vienna, Wien, Austria.

Abstract

Aim: To investigate the prognostic role of neutrophil percentage-to-albumin ratio (NPAR) in muscle-invasive bladder cancer (MIBC) patients treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).

Patients & methods: 213 patients were included.

Inclusion criteria: Nonmetastatic, MIBC (cT2-T4aN0M0), at least three cycles of NAC, undergone RC and with blood count within 30 days before NAC.

Results: Five-years overall survival (OS) with NPAR >18 was 34.06% (95% CI: 18.3-50.5) and 65.37% (95% CI: 52.4-75.6) with NPAR <18. Five years cancer-specific survival (CSS) with NPAR >18 was 42.9% (95% CI: 23.9-60.7) and 74.5% (95% CI: 62.6-83.1) with NPAR <18 (p < 0.001). In multivariable analysis, NPAR increased OS of 1.3 points and CSS of 4.37 points.

Conclusion: High NPAR prior to NAC seems to be a strong predictor of OS and CSS in MIBC patients treated with NAC and RC.

Keywords: bladder cancer; neoadjuvant chemotherapy; neutrophil percentage-to-albumin ratio; neutrophil-to-lymphocyte ratio; survival.