LAUSR

It was with interest that we read the article by Ojerholm et al reporting a secondary analysis of the recent SWOG 8710 trial assessing cystectomy with or without neoadjuvant chemotherapy in 317 patients with muscle-invasive bladder cancer. From the analysis, the authors concluded that the neutrophil-to-lymphocyte ratio (NLR) is neither a prognostic nor predictive biomarker for overall survival in patients with muscle-invasive bladder cancer. As the authors acknowledge, this finding was not consistent with previous studies that reported that the NLR has prognostic value in patients with bladder cancer and with a large section of the literature demonstrating that the NLR has prognostic value in a variety of common solid tumors as well as predictive value for the effectiveness of neoadjuvant chemotherapy. The difference between the current study by Ojerholm et al and the majority of the previously published literature was that the NLR was only analyzed as a continuous variable. The authors justified this approach as being statistically superior to analyses using standard thresholds (NLRs of 3 and 5) by concluding that all other reports were biased in some way. However, there also are reports of the NLR having prognostic value in prospectively collected data from clinical trials using standard thresholds, such as an NLR 3 or 5. These data question the conclusions of the study by Ojerholm et al, in particular that previous analyses using thresholds were statistically inappropriate. Therefore, in the interest of scientific balance, it would be important for the authors to also present their data using established thresholds for the NLR.