The prognostic role of the neutrophil-to-lymphocyte ratio in metastatic urothelial carcinoma.

Background: Systemic inflammation has been linked to cancer progression and survival outcomes. The neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker that may reflect this process in metastatic urothelial carcinoma (mUC). Objectives: To evaluate the prognostic impact of baseline NLR on overall survival in mUC patients receiving chemotherapy or immunotherapy. Design: A multicenter retrospective cohort study. Methods: We retrospectively analyzed 196 patients with advanced, unresectable urothelial carcinoma treated at four centers (Ankara University School of Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara Bilkent City Hospital, and Gazi University School of Medicine) between 2005 and 2023. These patients were stratified into high and low NLR groups using a cutoff of 4.2. Survival outcomes were assessed using Kaplan-Meier curves, and the prognostic significance of NLR was evaluated using univariate (log-rank test) and multivariate (Cox proportional hazards model) analyses. Results: The median overall survival (OS) for the entire cohort was 27 months (95% CI: 19.1-34.9). Patients with low NLR had significantly longer OS than those with high NLR (56.6 vs 14.6 months; p < 0.001). In multivariate analysis, NLR remained an independent predictor of OS after adjusting for age, liver metastases, and bone metastases (HR: 2.28, 95% CI: 1.37-3.81; p = 0.002). Conclusion: Elevated NLR is an independent prognostic marker in mUC, underscoring the role of systemic inflammation in cancer progression. These findings highlight the potential of NLR as a readily available biomarker for risk stratification in mUC, irrespective of treatment modality.