Biomarker NLR Found Not Predictive of Bladder Cancer Survival Interview with:

Eric Ojerholm, MD Resident, Radiation Oncology Hospital of the University of Pennsylvania

Dr. Eric Ojerholm

Eric Ojerholm, MD
Resident, Radiation Oncology
Hospital of the University of Pennsylvania What is the background for this study?

Response: Multiple studies reported that a blood test —the neutrophil-to-lymphocyte ratio (NLR)—might be a helpful biomarker for bladder cancer patients. If this were true, NLR would be very appealing because it is inexpensive and readily available. However, previous studies had several methodological limitations. What did you do in this study

Response: We therefore put NLR to the test by performing a rigorous “category B” biomarker study—this is a study that uses prospectively collected biomarker data from a clinical trial. We used data from SWOG 8710, which was a phase III randomized trial that assessed surgery with or without chemotherapy for patients with muscle-invasive bladder cancer. We tested two questions.

First, could NLR tell us how long a bladder cancer patient would live after curative treatment?

Second, could NLR predict which patients would benefit from chemotherapy before surgery? What are the main findings?

Response: Ultimately, we found that NLR was neither prognostic nor predictive for survival. In other words, it wasn’t helpful in predicting how long patients would live or which patients would do better with chemotherapy. These findings are in contrast with most previous studies of NLR in bladder cancer. What should readers take away from your report?

Response: I think this study gives some pause for NLR in bladder cancer. Further research is needed on this potential biomarker before it is used in clinical practice. What recommendations do you have for future research as a result of this study?

Response: Investigators can consider using clinical trial datasets to validate potential biomarkers, especially biomarkers derived from routine bloodwork. Clinical trial datasets have certain advantages over observational data, and it is important that we attempt to rigorously validate proposed biomarkers.

I would also add that ‘negative’ results are an expected and necessary part of the scientific process. One study showed that nearly 95% of all biomarker publications present ‘positive’ findings. We need researchers to publish high-quality negative studies so that the medical literature can more assuredly point us toward the truth. Thank you for your contribution to the community.


Neutrophil-to-lymphocyte ratio as a bladder cancer biomarker: Assessing prognostic and predictive value in SWOG 8710Eric Ojerholm, Andrew Smith, Wei-Ting Hwang, Brian C. Baumann, Kai N. Tucker, Seth P. Lerner, Ronac Mamtani, Ben Boursi and John P. Christodouleas

Cancer: 27 OCT 2016, DOI: 10.1002/cncr.30422

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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