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The University of Southampton
Inspire Medicine - Southampton

2nd prize INSPIRE Showcase Poster Presentation Competition 2015

Winner - Nish Morshed

Investigating neutrophil to lymphocyte ratio as a potential prognostic factor in patients undergoing neoadjuvant chemotherapy for bladder cancer


Bladder cancer is the seventh most common type of cancer in the UK. Treatment depends on the stage of the cancer and prognosis depends on various factors including tumour stage and grade. Survival of patients with muscle invasive bladder cancer is significantly prolonged when patients undergo neoadjuvant chemotherapy prior to local definitive treatment.

There is growing evidence that systematic inflammatory response plays a significant role in cancer mortality, however the theory is not fully understood. Neutrophil to lymphocyte ratio (NLR) has shown prognostic significance in many cancers, and could be a potential prognostic marker in patients with bladder cancer.


The aim of my project is to determine whether a link exists between NLR and prognosis in patients undergoing neoadjuvant chemotherapy for muscle invasive bladder cancer.


We performed a retrospective analysis of 94 patients receiving neoadjuvant chemotherapy between 2005 and 2011 for bladder cancer stage T2-T4a, N0, M0. Pre- treatment NLR and on-treatment NLR was calculated and updated onto a pre-existing and ethically approved database. Prognostic variables were tested by univariate Kaplan-Meier analyses and log rank tests. NLR was dichotomised at ≤3 vs > 3. Survival outcomes were measured by Kaplan-Meier curves and the differences assessed using log rank tests.


The overall median survival was 6.59 years. Patients with low NLR prior to chemotherapy had favourable survival (median survival not reached vs 2.3 years, 95% confidence interval 0-4.70,P = 0.005). Patients with low NLR also relapsed less (time to relapse not reached vs 2.17 years, confidence interval 0.48-3.89, P= 0.01). With respect to overall survival, patients that showed a dynamic change between pre-treatment NLR and on-treatment NLR had a statistically significant difference in survival (P = 0.000023).


NLR appears to function as a prognostic factor in patients undergoing neoadjuvant chemotherapy for muscle invasive bladder cancer.

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