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The impact of the change in the neutrophil-to-lymphocyte ratio (NLR) during neoadjuvant chemotherapy (NAC) on outcomes in patients with muscle-invasive bladder cancer (MIBC) is poorly understood. To evaluate the prognostic impact of the change in NLR during NAC for patients with MIBC. Patients referred to academic, community, and quaternary referral centres in Alberta, Canada from 2005 to 2015, Ontario, Canada from 2005 to 2013, and Southampton, UK from 2004 to 2010 were evaluated. 376 eligible patients were treated with NAC for clinical T2-4aN0M0 disease, and 296 were evaluable for the change in NLR. A high NLR was defined as being an NLR > 3. Relationships between the change in NLR from baseline to mid-NAC (pre-cycle 3) and outcomes were analyzed using multivariable Cox regression. Kaplan-Meier analysis was used with the log-rank test for group comparisons. Median follow-up was 22.0 months (95% confidence interval [CI]: 14.9–30.0). Patients with a sustained high NLR had a median disease-free survival (DFS) of 12.6 months, compared to 34.8 months for those with a sustained low NLR (log-rank test p = 0.0025; hazard ratio [HR] 0.61 [95% CI: 0.44–0.84]). Median overall survival (OS) was 19.4 months for patients with a sustained high NLR, compared to 44.0 months for patients with a sustained low NLR (log-rank test p = 0.0011; HR 0.54 [95% CI: 0.38–0.77]). A sustained high NLR from baseline to mid-NAC is an independent prognostic factor for patients with MIBC.

The aim of this study was to assess the changes in 2-year conditional survival (CS) rates after first-line chemotherapy for metastatic urothelial cancer (UC) and to determine how well established prognostic factors evolve over time in these patients. Our results showed that patients with hemoglobin (Hb) levels < 12 g/dL had a significantly poorer survival, although this difference tended to disappear over time. In addition, patients with neutrophil to lymphocyte ratio (NLR) < 3 and age < 70 years showed an increase in their conditional overall survival (COS) and conditional progression-free survival (CPFS) over time. In conclusion, the conditional probability of survival at 2 years from the start of first-line chemotherapy for advanced UC changes over time according to clinical characteristics.