The Hemoglobin-Red Cell Distribution Width and Neutrophil -Lymphocyte Ratio in Predicting Lamina Propria Invasion in Bladder Tumors?

Abstract

Purpose: To investigate the importance of the Hemoglobin/Red cell distribution width ratio (Hb/RDW) and Neutrophil/Lymphocyte ratio (NLR) in predicting bladder lamina propria invasion before transurethral resection in non-muscular invasive bladder cancer (NMIBC) patients

Methods: The data of the patients whose pathology after transurethral resection of the bladder was NMIBC between January 2010 and June 2016 were evaluated retrospectively. Group 1 had Ta (mucosa involvement) and Group 2 had T1 (submucosa involvement) lesions. The age, gender, tumor size and number of tumors of the patients were identified. The preoperative blood leucocyte (WBC), hemoglobin (Hb), neutrophil (N), lymphocyte (L), monocyte (M), platelet (PLT), mean platelet volume (MPV), and red cell distribution width (RDW) values were identified and the NLR, PLR, LMR values calculated. The Hb/RDW ratio was determined.

Results: A total of 369 patients were evaluated. The mean age was similar between groups. Group 1 (Ta) consisted of 219 patients (66.3±10.7 years) and Group 2 (T1) 150 patients (66.9±10.4 years) (p=0.638). NLR was higher in Group 2 than Group 1 (2.4 (1.5) and 2.2 (1.5), respectively, p=0.042) and this difference was statistically significant. The Hb/RDW ratio in Group 2 was lower than in Group 1 (0.89±21 and 0.94±19, respectively, p=0.019) and this difference was statistically significant.

Conclusion: We believe that a decrease in the Hb/RDW ratio and increase in NLR, which can be easily determined from the peripheral blood in the preoperative period, can be associated with lamina propria invasion (T1). These studies should be supported with prospective large series.

 

Keywords

• Non-muscular invasive bladder cancer,Hemoglobin-red cell distribution width ratio,Neutrophil-lymphocyte ratio,Lamina propria invasion.

Mesane Tümörlerinde Hemoglobin-Redcell Distrubition Width Oranı (Hb/RDW) ve Neutrophil- Lymphocyte Oranı (NLR) Lamina Propria İnvazyonunu Tahmin Etmede Kullanılabilir mi?

Abstract

Amaç: Non-musculer invazive bladder cancer (NMIBC) hastalarında Hemoglobin-Red cell Distrubition Width oranı (Hb/RDW) ve Nötrofil/Lenfosit oranının (NLR) mesanenin transüretral rezeksiyonu öncesi lamina propria invazyonunu önğörmede önemini araştırmak.

Materyal–methods: Ocak 2010- Haziran 2016 yılları arası mesanenin transüretral rezeksiyonu sonrası patolojisi NMIBC olan hastaların verileri retrospektif değerlendirildi. Hastalar Grup 1: Ta (mukoza tutulumu), Grup 2: T1 (submukoza tutulumu) olarak 2 gruba ayrıldılar. Hastaların yaşları, cinsiyetleri, tümör boyutu ve tümör sayıları belirlendi. Preoperatif tam kan değerlerinden lökosit (WBC), hemoglobin (Hb), nötrofil (N), lenfosit (L), monosit (M), platelet (PLT), mean platelet volümü (MPV), Red cell Distrubition Width (RDW) değerleri belirlendikten sonra NLR, PLR, LMR değerleri hesaplandı. Hb/RDW oranı belirlendi.

Bulgular: Patolojik evresi NMIBC olan 369 hasta değerlendirildi. Gruplar arasında yaş farkı yoktu. Grup 1 (Ta); 219 hasta, 66.3±10.7 yıl olup grup 2 (T1); 150 hasta, 66.9±10.4 yıl oldu (p=0.638). NLR grup 2’de grup 1’den yüksek olup (sırasıyla 2.4 (1.5), 2.2 (1.5) ve p=0.042 ) istatistiksel olarak bu yükseklik anlamlıdır. Gruplar arasında Hb ve RDW oranları bakımından farklılık izlenmemesine rağmen Hb/RDW oranı grup 2’de grup 1’den düşüktür (sırasıyla 0.89±21, 0.94±19 ve p=0.019) ve istatistiksel olarak bu azalma anlamlıdır.  

Sonuç: Preoperatif dönemde periferik kandan kolay yolla elde edilebilen Hb/RDW oranında azalma ve NLR yükselmenin lamina propria invazyonu (T1) ile ilişkili olabileceğini düşünmekteyiz. Bu çalışmaların prospektif geniş serili çalışmalarla desteklenmesi gerekir.

Keywords

• kasa invaze olmayan mesane kanseri,hemoglobin-red cell distrubition oranı,nötrofil-lenfosit oranı,lamina propria invazyonu

References

1. 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians. 2015; 65:87-108.
2. 2. Anastasiadis A, de Reijke TM. Best practice in the treatment of non-muscle invasive bladder cancer. Ther Adv Urol. 2012;4:13-32.
3. 3. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Compérat E et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 2013;64:639e53.
4. 4. Sylvester RJ, van der Meijden AP, Oosterlinck W. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49:466-5.
5. 5. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436-444.
6. 6. Al-Zalabani AH, Stewart KF, Wesselius A, Schols AM, Zeegers MP. Modifiable risk factors for the prevention of bladder cancer: a systematic review of meta-analyses. Eur J Epidemiol. 2016;31(9):811-51. 7. Kumar R, Geuna E, Michalarea V, Guardascione M, Naumann U, Lorente D et al. Theneutrophil-lymphocyte ratio and itsutilisation for the management of cancer patients in early clinical trials. Br J Cancer. 2015;112:1157–1165.
7. 8. Bugada D, Allegri M, Lavand'homme P, De Kock M, Fanelli G. Inflammation-based scores: a new method for patient-targeted strategies and improved perioperative outcome in cancer patients. Biomed Res Int. 2014;2014:142425.
8. 9. Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K et al. Prognosticvalue of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology 2012;79:1085e91.

9. 10. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133:628–632.
10. 11. Kemal Y, Demirag G, Baş B, Önem S, Teker F, Yücel İ. The value of red blood cell distribution width in endometrial cancer. Clin Chem Lab Med 2015;53:823–827.
11. 12. Koma Y, Onishi A, Matsuoka H, Oda N, Yokota N, Matsumoto Y et al. Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer. PloS One 2013;8:e80240. 13. Albayrak S, Zengin K, Tanik S, Bakirtas H, Imamoglu A, Gurdal M. Red cell distribution width as a predictor of prostate cancer progression. Asian Pac J Cancer Prev 2014;15:7781e4.
12. 14. Sun P, Zhang F, Chen C, Bi X, Yang H, An X et al. The ratio of hemoglobin to red cell distribution width as a novel prognostic parameter in esophageal squamous cell carcinoma: a retrospective study from southern China. Oncotarget. 2016 5;7(27):42650-42660. 15. Gao L, Zhang H, Zhang B, Zhang L, Wang C. Prognostic value of combination of preoperative platelet count and mean platelet volume in patients with resectable non-small cell lung cancer. Oncotarget. 2017;28;8(9):15632-15641.
13. 16. Hu L, Li M, Ding Y, Pu L, Liu J, Xie J et al. Prognostic value of RDW in cancers: a systematic review and meta-analysis. Oncotarget. 2017; 28;8(9):16027-16035. 17. Bhindi B, Hermanns T, Wei Y, Yu J, Richard PO, Wettstein MS et al. Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy. Br J Cancer 2016 ;114(2):207-212.
14. 18. Michaud DS. Chronic inflammation and bladder cancer. Urol Oncol 2007; 25: 260-268.
15. 19. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 2014;23:31-39.
16. 20. Mano R, Baniel J, Shoshany O, Margel D, Bar-On T, Nativ O et al. Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle-invasive bladder cancer. Urol Oncol. 2015;33:67.e1-7.
17. 21. Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK. Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy. J Endourol 2013;27:1046e50.
18. 22. Can C, Baseskioglu B, Yılmaz M, Colak E, Ozen A, Yenilmez A. Pretreatment parameters obtained from peripheral blood sample predicts invasiveness of bladder carcinoma. Urol Int. 2012;89(4):468-472.
19. 23. Ceylan C, Doluoglu OG, Keleş I, Gazel E, Temuçin T, Odabaş Ö et al. Importance of the neutrophil-to-lymphocyteratio in muscle-invasive and non-muscle invasive bladder tumors. Urologia 2014;81:120e4.
20. 24. Wei Y, Jiang YZ, Qian WH. Prognostic role of NLR in urinary cancers: a meta-analysis. PLoS One. 2014 Mar 18;9(3):e92079.
21. 25. Cimen HI, Halis F, Saglam HS, Gokce A. Can neutrophil to lymphocyte ratio predict lamina propria invasion in patients with non muscle invasive bladder cancer? Int Braz J Urol. 2017;43(1):67-72.
22. 26. Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood. 2015;126(5):582-8.
23. 27. Meikle CK, Kelly CA, Garg P, Wuescher LM, Ali RA, Worth RG. Cancer and thrombosis: The platelet perspective. Front Cell Dev Biol. 2017;4:147.
24. 28. Solakhan M, Demirpence O, Orhan N, Yildirim OA, Guzel E, Yildirim M. Lack of any role of systemic Inflammatory responses in predicting muscle invasion by bladder cancer. Asian Pac J Cancer Prev. 2016;17(8):3737-9.
25. 29. Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb). 2016;26(2):178-193.
26. 30. Coban S, Keles I, Biyik İ, Guzelsoy M, Turkoglu AR, Ocak N et al. Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels? Canadian Urological Association Journal, 2015; 9.1-2: E5.