Validation of the neutrophil-to-lymphocyte ratio as a prognostic factor in a cohort of European prostate cancer patients

Associations between inflammatory burden index, prostate cancer, and mortality among middle-aged and elderly individuals

BACKGROUND

Inflammation plays a crucial role in prostate cancer (PCa) progression and mortality. This study aimed to investigate the predictive value of the inflammatory burden index (IBI) and its components for mortality risk among men aged 40 years and older.

METHODS

A total of 7,344 participants from the NHANES 2001-2010 were included. High PCa risk was defined as a %fPSA greater than 25% and a tPSA level less than 4.0 ng/mL. Cox regression and logistic regression analyses were conducted to assess the association between IBI, PCa risk, and mortality. Receiver operating characteristic (ROC) curve analysis and random survival forest (RSF) model were utilized to evaluate the predictive value of IBI and its components for mortality.

RESULTS

Elevated IBI levels were significantly associated with an increased risk of all-cause mortality (HR = 1.08 [1.05-1.10]) and cancer mortality (HR = 1.11 [1.07-1.15]). High-risk PCa cases also exhibited elevated mortality risk (all-cause: HR = 1.35 [1.19-1.54]; cancer: HR = 1.65 [1.27-2.14]). Additionally, the combined effect of elevated IBI levels and high PCa risk showed a synergistic impact on mortality outcomes (all-cause: HR = 1.49 [1.27-1.74]; cancer: HR = 1.76 [1.29-2.40]). ROC curve analysis revealed that IBI had the highest AUC for predicting all-cause mortality (AUC = 0.690 at 3 years, 0.622 at 5 years, 0.634 at 10 years, and 0.632 at 15 years) compared to its individual components (CRP, NEU, LYM). RSF analysis highlighted IBI as the most significant predictor of all-cause and cancer mortality.

CONCLUSION

The combined effect of elevated IBI levels and high PCa risk demonstrated a synergistic impact on increased mortality risk among men aged 40 years and older. IBI demonstrated superior predictive performance for mortality outcomes compared to individual inflammatory markers. These findings underscore the potential utility of IBI as a prognostic biomarker for mortality risk assessment in individual with high PCa risk.

Prognostic Implications of Blood Immune-Cell Composition in Metastatic Castration-Resistant Prostate Cancer

The prognosis for patients with metastatic castration-resistant prostate cancer (mCRPC) varies, being influenced by blood-related factors such as transcriptional profiling and immune cell ratios. We aimed to address the contribution of distinct whole blood immune cell components to the prognosis of these patients. This study analyzed pre-treatment blood samples from 152 chemotherapy-naive mCRPC patients participating in a phase 2 clinical trial (NCT02288936) and a validation cohort. We used CIBERSORT-X to quantify 22 immune cell types and assessed their prognostic significance using Kaplan-Meier and Cox regression analyses. Reduced CD8 T-cell proportions and elevated monocyte levels were substantially connected with a worse survival. High monocyte counts correlated with a median survival of 32.2 months versus 40.3 months for lower counts (HR: 1.96, 95% CI 1.11-3.45). Low CD8 T-cell levels were associated with a median survival of 31.8 months compared to 40.3 months for higher levels (HR: 1.97, 95% CI 1.11-3.5). These findings were consistent in both the trial and validation cohorts. Multivariate analysis further confirmed the independent prognostic value of CD8 T-cell counts. This study highlights the prognostic implications of specific blood immune cells, suggesting they could serve as biomarkers in mCRPC patient management and should be further explored in clinical trials.

Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with non-metastatic and metastatic prostate cancer: A meta-analysis and systematic review

Objective

To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in prostate cancer (PCa) patients stratified in non-metastatic and metastatic diseases.

Methods

A literature search process was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In our meta-analysis, the pooled event rate estimated and the pooled hazard ratio were calculated using a random effect model.

Results

Forty-two articles were selected for our analysis. The pooled risk difference for non-organ confined PCa between high and low NLR cases was 0.06 (95% confidence interval [CI]: -0.03-0.15) and between high and low PLR cases increased to 0.30 (95% CI: 0.16-0.43). In non-metastatic PCa cases, the pooled hazard ratio for overall mortality between high and low NLR was 1.33 (95% CI: 0.78-1.88) and between high and low PLR was 1.47 (95% CI: 0.91-2.03), whereas in metastatic PCa cases, between high and low NLR was 1.79 (95% CI: 1.44-2.13) and between high and low PLR was 1.05 (95% CI: 0.87-1.24).

Conclusion

The prognostic values of NLR and PLR in terms of PCa characteristics and responses after treatment show a high level of heterogeneity of results among studies. These two ratios can represent the inflammatory and immunity status of the patient related to several conditions. A higher predictive value is related to a high NLR in terms of risk for overall mortality in metastatic PCa cases under systemic treatments.

The Values of Systemic Immune-Inflammation Index and Neutrophil-Lymphocyte Ratio in Predicting Biochemical Recurrence in Patients With Localized Prostate Cancer After Radical Prostatectomy

Purpose

To investigate the association between preoperative systemic immune-inflammation index (SII) and neutrophil-lymphocyte ratio (NLR) and oncological outcomes in localized prostate cancer (PCa) patients after radical prostatectomy (RP).

Methods

Between January 2014 and December 2019, 291 patients with pathologically confirmed localized PCa who underwent RP were included in this study. The threshold values of SII and NLR for biochemical recurrence (BCR) were calculated according to Youden's index based on the receiver operating characteristic (ROC) curve, then the patients were divided into two groups by the threshold values of SII and NLR, and the clinicopathological outcomes were analyzed and compared between groups, respectively. The binary logistic regression model was used to evaluate the association between SII, NLR, and pathological outcomes including Gleason score (GS) and pathological T (pT) stage. Kaplan-Meier curves and univariable and multivariable Cox regression models were used to determine the association between high SII, high NLR, and BCR-free survival, respectively.

Results

The median follow-up time was 48 months (IQR 36-62), and 114 (39.18%) patients developed BCR. The AUC of SII for BCR was 0.813 (P < 0.001), with a threshold value of 528.54, a sensitivity of 72.9%, and a specificity of 76.3%; the AUC of NLR for BCR was 0.824 (P < 0.001), with a threshold value of 2.62, a sensitivity of 71.2%, and a specificity of 81.6%. Patients were divided into two groups according to the threshold values of SII and NLR, respectively. Patients in the high SII group had higher tPSA, GS, pT stage, and BCR rate than patients in the low SII group (P = 0.004, 0.04, 0.007, and <0.001, respectively), and patients in the high NLR group had higher tPSA, GS, pT stage, and BCR rate than patients in the low NLR group (P = 0.04, 0.02, 0.006, and <0.001, respectively). Multivariable logistic regression analysis revealed that high SII was significantly correlated with adverse pathological outcomes of GS (HR, 1.656; 95% CI, 1.00-2.742, P = 0.042) and pT stage (HR, 1.478; 95% CI, 0.972-3.64, P = 0.028); there was no association between high NLR and pathological events. Kaplan-Meier analysis showed significantly poorer BCR-free survival in patients with high SII or high NLR (P < 0.001 and <0.001, respectively). By using the multivariable Cox regression model, high SII (HR, 4.521; 95% CI, 2.262-9.037, P < 0.001) and high NLR (HR, 4.787; 95% CI, 2.339-9.798, P < 0.001) were both significant predictors of BCR after RP.

Conclusion

High SII was significantly related to unfavorable clinicopathological outcomes. High preoperative SII and NLR were related to higher BCR rate in localized PCa after RP, and they were all independent risk factors associated with shorter BCR-free survival. These two factors might provide promising and inexpensive methods for predicting clinical outcomes in patients with RP.

Predicting the diagnosis of prostate cancer with a scoring system based on novel biomarkers

Objective

To predict prostate cancer using novel biomarker ratios and create a predictive scoring system.

Materials and methods

Data of a total of 703 patients who consulted Urology Department of Selayang Hospital between January 2013 and December 2017 and underwent prostate biopsy were screened retrospectively. Prostate specific antigen (PSA) levels, prostate volumes (PV), neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), Prostate specific antigen density (PSAD) and histopathology were evaluated.

Results

Ages ranged from 43 to 89 years, divided into 2 groups as per biopsy results; positive for prostate cancer (n = 290, 41.3%) and negative for malignancy (n = 413; 58.7%). Intergroup comparative evaluations were performed. Independent variables with p < 0.001 in the univariate analysis were age, DRE, PV, NLR, PSAD. A scoring system was modelled using NLR < 0.9, PSAD > 0.4, Age > 70 and DRE. A score of 2 or more predicted prostate cancer with a Sensitivity of 83.8% and Specificity of 86.4%.

Conclusions

NLR is shown to be good predictor for prostate cancer its usage in this scoring system affords more disease specificity as compared to PSA alone.

Validation of the Effectiveness of Neutrophil-to-lymphocyte Ratio (NLR) as a Predictive Factor in Patients Undergoing Prostate Biopsy With Prostate Specific Antigen (PSA) Between 4.0 and 10.0 ng/ml

BACKGROUND/AIM

This study aimed to access the effectiveness of serum neutrophil-to-lymphocyte ratio (NLR) in patients undergoing prostate needle biopsy with a prostate specific antigen (PSA) between 4.0 and 10.0 ng/ml.

PATIENTS AND METHODS

A total of 633 cases were eligible. We evaluated several factors including age, PSA, PSA-density (PSAD), platelet-to-lymphocyte ratio (PLR) and NLR in the presence or absence of prostate cancer (PCa), retrospectively. We evaluated statistically the associations between each factor and pathological findings or Gleason score.

RESULTS

A total of 201 were evaluated in this study. Regarding the presence or absence of prostate cancer, there were statistically significant differences in age, PSA levels, PSAD, the PLR and NLR. The mean NLR value of the patients with PCa was significantly lower compared to the entire cohort. Multivariate analysis showed that age, PSAD, and NLR were independent risk factors predicting PCa.

CONCLUSION

For patients having a PSA between 4.0 and 10.0 ng/ml, NLR was a predicting factor of PCa prior to prostate needle biopsy and an effective biomarker and useful tool for avoiding unnecessary biopsies.

Inflammatory factor-based prognostic risk stratification for patients with metastatic castration-resistant prostate cancer treated with docetaxel

To develop a simple inflammatory factor-based prognostic risk stratification system for patients with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel as the initial treatment, we reviewed the data of 399 consecutive patients who received first-line docetaxel chemotherapy between January 2013 and June 2019 retrospectively. The optimal cut-off values for the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in terms of survival were calculated by ROC curves. Patients were stratified into favourable (lower NLR and lower PLR), intermediate (higher NLR and lower PLR, or lower NLR and higher PLR) and poor (higher NLR and higher PLR) groups. Kaplan-Meier curves were drawn to evaluate overall survival (OS) and progression-free survival (PFS). The ROC curve analysis determined the cut-offs for the NLR and PLR to be 2.355 and 104.275 respectively. Multivariate Cox regression analysis showed that being in the poor patient group (NLR ≥2.355 and PLR ≥104.275) was an independent prognostic risk factor and Kaplan-Meier curves analysis revealed that respondents with NLR <2.355 and PLR <104.275 had significantly longer OS and PFS. So it can be concluded that concurrently high NLR and PLR values are predictors for poor chemotherapy outcomes after androgen deprivation therapy failure in patients with mCRPC.

Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with metastatic castration resistant prostate cancer treated with Abiraterone or Enzalutamide

BACKGROUND

Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are markers of systemic inflammation associated with poor outcome in several solid tumours. We retrospectively investigated the prognostic role of PLR and, secondly, NLR in mCRPC patients treated with Abiraterone Acetate (AA) or Enzalutamide (E), both in pre- and post-docetaxel setting.

MATERIALS AND METHODS

225 mCRPC patients treated with AA or E with basal blood count were divided in three groups according to PLR (PLR1 <128; PLR2 128-190; PLR >190) and in two groups according to NLR (<3 vs ≥3). Outcome measures were progression-free survival (PFS) and overall-survival (OS). Univariate and multivariate analyses were performed.

RESULTS

110 patients were in PLR1, 58 in PLR2 and 57 in PLR3. Median OS was 22.0, 20.6 and 21.2 months in PLR1, PLR2 and PLR3 (PLR2 vs PLR1: HR 0.97, 95%CI 0.62-1.52, p=0.90; PLR3 vs PLR1: HR 1.37, 95%CI 0.90-2.08, p=0.14). Median PFS was 9.2, 12.7 and 8.5 months in PLR1, PLR2 and PLR3 (PLR2 vs PLR1: HR 0.87, 95%CI 0.59-1.27, p=0.47; PLR3 vs PLR1: HR 1.15, 95%CI 0.80-1.66, p=0.45). 142 patients were in NLR<3 and 83 in NLR≥3. Median OS was 26.5 months in NLR<3 and 17.0 months in NLR≥3 (HR 1.75, 95%CI 1.22-2.51, p=0.02). Median PFS was 10.1 months in NLR<3 and 7.6 months in NLR≥3 (HR 1.37, 95%CI 1.00-1.88, p=0.05).

CONCLUSIONS

In this retrospective analysis of mCRPC patients treated with AA or E we did not identify a prognostic role of baseline PLR, while we found a significant prognostic role of baseline NLR.

Correlation between neutrophil-to-lymphocyte ratio with Gleason score in patients with prostate cancer at Adam Malik Hospital Medan 2013 - 2015

Context:

A grading system was created by Donald F. Gleason for prostate cancer as prognostic indicators. The neutrophil-to-lymphocyte ratio (NLR) was found that it could be a prognostic factor in solid tumors.

Aims:

This study aims to assess whether there is a correlation between NLR with the results of the Gleason score of patients with prostate adenocarcinoma biopsy at Haji Adam Malik Hospital Medan.

Settings and Design:

A total of 121 patients underwent a prostate biopsy from early January 2013 to December 2015 at Adam Malik Hospital.

Subjects and Methods:

Of the 121 patients, thirty were not included in the study because of incomplete baseline data and a history of hematological abnormalities. Data from 91 patients were then taken, including age, hematologic data prebiopsy, prostate-specific antigen (PSA) on initial examination, prostate weight estimation, and Gleason scores from biopsy results.

Statistical Analysis Used:

The data are processed with SPSS version 22.

Results:

A significant moderate strength correlation was found between NLR and Gleason Score (r = 0.572; P = 0.001). However, no statistically significant correlation found between NLR and prostate weight estimation (r = 0.077; P = 0.469) and NLR with PSA (r = 0.072; P = 0.496).

Conclusions:

A significant correlation between the neutrophil-to-lymphocyte ratio and the Gleason score was noted. Further studies are needed to confirm these findings.

Systemic Inflammatory Markers Are Predictive of the Response to Brachytherapy in the Prostate

We analyzed the influence of the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) on the biochemical recurrence (BCR) in low-intermediate risk prostate cancer (PCa). A total of 604 patients treated with exclusive brachytherapy for low- and intermediate-risk cancers were included in this study. No patient received either androgen deprivation or brachytherapy as a boost. BCR was defined according to the Phoenix definition (nadir prostatic specific antigen (PSA) +2). The median follow-up was 60 months (IQR 44–48 months). An NLR > 3 was more frequent in statin users (p = 0.025), but not in diabetics (p = 0.079). In univariate analysis (UVA) and multivariate analysis (MVA), a NLR > 3 (MVA p = 0.03), as well as Cancer of the Prostate Risk Assessment (CAPRA) low- vs. intermediate-risk (MVA p = 0.04), were predictive of BCR. When combining the NLR score with the CAPRA risk group, CAPRA intermediate risk patients with an NLR ≤ 3 (n = 157) had the worst (p = 0.0276) BCR rates, with a 5-year recurrence-free survival (p = 0.004, Bonferroni correction for six comparisons p = 0.024). We were able to identify a subgroup of PCa patients with CAPRA intermediate-risk and an NLR ≤ 3 who had worse BCR. This is in contrast to most other cancers, which have a worse prognosis when the NLR is high.

Role of the neutrophil/lymphocyte ratio in patients with metastatic castration-resistant prostate cancer treated first-line with abiraterone

INTRODUCTION

In patients with prostate cancer, high NLR seems to be associated with worse survival. Abiraterone acetate (AA) is a new generation hormonal treatment that has shown to increase PFS and OS in mCRPC.

MATERIAL AND METHODS

Retrospective analysis of patients treated with AA in our center (December 2012-September 2018). We analyzed the association of the NLR (< or ≥ 3) before and after 6 months of treatment with PSA response, PFS, OS, and hormone sensitivity prior to AA (< or> 12 months).

RESULTS

We have treated 56 patients with a median age of 82 (62-94), of which 22 (39%) had NLR ≥ 3 before treatment. There is a statistically significant association between the NLR prior to treatment<3 and PSA response, OR=9,444, P=.001, and there was no association with the NLR at 6 months of treatment. Statistically significant differences were found between the groups of NLR<and> 3 prior to treatment with abiraterone in PFS with 15 months of median vs. 9 and P=.008, and in OS with 20 months vs. 9 with P=.014. With respect to the determination of NLR at 6 months, there are no differences in the survival curves between both groups. There are significant differences between the NLR prior to treatment according to the length of hormone sensitivity (P=.026).

CONCLUSIONS

Our results suggest that NLR could provide relevant information and could act as an early and accessible prognostic marker in patients with mCRPC in first line treatment with Abiraterone.

Treatment Stratification of Patients with Metastatic Castration-Resistant Prostate Cancer by Machine Learning

Prostate cancer is the most common cancer in men in the Western world. One-third of the patients with prostate cancer will develop resistance to hormonal therapy and progress into metastatic castration-resistant prostate cancer (mCRPC). Currently, docetaxel is a preferred treatment for mCRPC. However, about 20% of the patients will undergo early therapeutic failure owing to adverse events induced by docetaxel-based chemotherapy. There is an emergent need for a computational model that can accurately stratify patients into docetaxel-tolerable and docetaxel-intolerable groups. Here we present the best-performing algorithm in the Prostate Cancer DREAM Challenge for predicting adverse events caused by docetaxel treatment. We integrated the survival status and severity of adverse events into our model, which is an innovative way to complement and stratify the treatment discontinuation information. Critical stratification biomarkers were further identified in determining the treatment discontinuation. Our model has the potential to improve future personalized treatment in mCRPC.

Predictive Value of Neutrophil to Lymphocyte Ratio in the Diagnosis of Significant Prostate Cancer at Initial Biopsy: A Comparison with Free Percent Prostate Specific Antigen, Prostate Specific Antigen Density and Primary Circulating Prostate Cells

Introduction:

An elevated serum PSA is the only biomarker routinely used in screening for prostate cancer to indicate a prostate biopsy. However, it is not specific for prostate cancer and the neutrophil/lymphocyte ratio has been suggested as an alternative. We present a prospective study of men with an elevated PSA and compare the neutrophil/lymphocyte ratio, free percent PSA, PSA density and the presence of circulating prostate cells to detect clinically significant prostate cancer at first biopsy.

Patients and Methods:

Prospective study of consecutive men with a PSA 4-10 ng/ml referred for initial prostate biopsy, the results were compared with the neutrophil/lymphocyte ratio, free percent PSA and PSA density. Circulating prostate cells (CPCs) were detected using immunocytochemistry. The blood sample was taken immediately before the prostate biopsy.

Results:

1,223 men participated, 38% (467) of whom had prostate cancer detected, of these 322 were clinically significant. The area under the curves were for neutrophil/lymphocyte ratio, free percent PSA, PSA density and CPC detection were 0.570, 0.785, 0,620 and 0.844 respectively. Sensitivity/specificity were 0.388/0.685, 0.419/0.897, 0.598/0.624 and 0.966/0.786 respectively. The neutrophil/lymphocyte ratio did not differentiate between benign and malignant disease.

Conclusions:

The neutrophil/lymphocyte ratio did not discriminate between benign and malignant prostatic disease in patients with a PSA between 4-10ng/ml.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer

OBJECTIVES

NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer.

METHODS

This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation.

RESULTS

There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels.

CONCLUSION

In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.

A meta-analysis of the impact of neutrophil-to-lymphocyte ratio on treatment outcomes after radiotherapy for solid tumors

BACKGROUND

To evaluate the impact of neutrophil-to-lymphocyte ratios (NLR) as a prognostic factor in predicting treatment outcomes after radiotherapy (RT) for solid tumors.

METHODS

PubMed and Embase databases were used to search for articles published by February 2019 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Hazard ratios (HR) with 95% confidence intervals (CI) were used to evaluate the association between NLR levels and treatment outcomes after RT. The primary endpoint was overall survival (OS) rates. Secondary endpoints included progression-free survival, disease-free survival, and disease-specific survival rates.

RESULTS

Thirty-eight datasets with a total of 7065 patients were included in the meta-analysis. Patients with high pretreatment NLR demonstrated significantly worse OS with a pooled HR of 1.90 (95% CI 1.66-2.17, P < .001). In patients receiving RT alone, the pooled HR for OS was 1.71 (95% CI 1.44-2.04, P < .001) with no between-study heterogeneity (I = 0%, P = .46).

CONCLUSION

Elevated pretreatment NLR is associated with poorer survival in cancer patients undergoing RT. Elevated pretreatment NLR prior to RT initiation may be a useful biomarker to predict treatment outcomes and select a subgroup of patients in need of a more aggressive treatment approach.

Prognostic significance of elevated pretreatment systemic inflammatory markers for patients with prostate cancer: a meta-analysis

Background

Pretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa). However, the prognostic effects remain controversial. Therefore, the goal of this study was evaluate the prognostic values of these markers for PCa patients using a meta-analysis.

Methods

Potentially relevant publications in PubMed and Cochrane Library were searched. Pooled hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), recurrence free survival (RFS) and distant metastases-free survival (DMFS) were determined using a fixed or random effects model by STATA 13.0 software.

Results

Thirty-two studies involving 21,949 participants were included. Our pooled results demonstrated that a high pretreatment NLR (HR = 1.55, 95% CI 1.37–1.76), PLR (HR = 1.72; 95% CI 1.36–2.18), neutrophil (HR = 1.10; 95% CI 1.03–1.18 and monocyte counts (HR = 2.25; 95% CI 1.67–3.05) predicted inferior OS, while elevated pretreatment LMR (HR = 2.27; 95% CI 1.76–2.94) was correlated with favorable OS. Furthermore, the higher NLR (HR = 1.62; 95% CI 1.29–2.04) and monocyte counts (HR = 1.75; 95% CI 1.36–2.25), but lower LMR predicted worse PFS (HR = 2.18; 95% CI 1.58–3.02); poor RFS was only associated with NLR (HR = 1.12; 95% CI 1.04–1.20). The subgroup analysis showed that the higher NLR may be a predictive factor for OS only in patients with mCRPC and undergoing chemotherapy; while the higher PLR was only significantly associated with OS in localized PCa regardless of treatment.

Conclusion

This meta-analysis reveals that pretreatment NLR, PLR, LMR, neutrophil, and monocyte counts may be effective predictive biomarkers for prognosis in patients with PCa.

The preoperative neutrophil-to-lymphocyte ratio is not a marker of prostate cancer characteristics but is an independent predictor of biochemical recurrence in patients receiving radical prostatectomy

The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic marker in prostate cancer. In this study, we assessed the association between preoperative NLR and the clinicopathological characteristics, biomolecular features and prognosis of patients with localized prostate cancer treated with radical prostatectomy. A total of 994 subjects were retrospectively enrolled, and the histological specimens of 210 patients were retrieved for constructing a tissue microarray. Immunohistochemistry was then performed to assess the expression of AR, ERG, PTEN, p-AKT, Bcl-2, Beclin-1, Ki-67, CD3, CD4, CD8, IFN-γ and TNF-α. No significant differences in the NLR distributions among clinicopathological variables were observed (P > 0.05) when the original NLR data were utilized. When we dichotomized the NLR value into the high-NLR group (NLR ≥ 2) and low-NLR group (NLR < 2), we found that the patients in the high-NLR group had more prostate capsule invasion (P = 0.047). Additionally, no significant correlation was found between the NLR and infiltrating CD3⁺ cells, the CD4/CD8 ratio, AR, ERG, PTEN, p-AKT, Bcl-2, Beclin-1, Ki-67, IFN-γ or TNF-α (P > 0.05). When we analyzed the data of patients without postoperative adjuvant hormone therapy or radiotherapy, univariate and multivariate survival analysis indicated that a high NLR was a predictor of better BCR-free survival (P < 0.05). When analyzing the entire cohort, univariate survival analysis showed that the high-NLR group had significantly poorer overall survival (P < 0.05). In conclusion, NLR cannot reflect prostate cancer characteristics or the local immune microenvironment, but a high NLR can serve as an independent predictor of better BCR.

Prognostic utility of neutrophil-to-lymphocyte and platelets-to-lymphocyte ratio in predicting biochemical recurrence post robotic prostatectomy

Aim: Utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting biochemical recurrence (BCR) in patients with localized prostate cancer. Materials & methods: Retrospective analysis of patients operated by robot-assisted radical prostatectomy. Variables included were: NLR, PLR pre-operative prostate specific antigen, pathological Gleason score, surgical margins status, extracapsular extension, seminal vesical invasion, and lymph node status. Results: Out of 321 patients, no association between NLR or PLR and BCR was detected. Predictors of BCR were pathological Gleason score, extracapsular extension and positive surgical margins. On multivariate analysis, the Gleason Score, extracapsular extension and positive surgical margins remained the only predictors of BCR. Conclusion: Neither elevated NLR nor PLR predicted an increased risk of BCR.

A Combination of Testosterone and White Blood Cell Count as a Predictive Factor of Overall Survival in Localized Prostate Cancer

BACKGROUND

It has been shown that neutrophil count or an elevated neutrophil-to-lymphocyte ratio (NLR) as well as testosterone levels are separately associated with increased mortality in patients with localized prostate cancer.

OBJECTIVE

We tested a combination of testosterone levels and white blood cell (WBC) counts to predict overall survival (OS) in a prospective cohort of patients treated with radiotherapy for localized prostate cancer.

PATIENTS AND METHODS

The 381 patients included in this study were prospectively enrolled in phase 2 or 3 studies. Multivariate Cox proportional hazards models were used to analyze the influence of WBC count and testosterone level on biochemical recurrence and OS. Cutoff levels of ≤10.4 nmol/L (300 ng/dL) for testosterone and a median value of 6.2 (×10⁹/L) for WBC count were used.

RESULTS

The median follow-up for biochemical recurrence and OS were 72 and 78 months, respectively. A WBC count of ≥6.2 alone was not associated with OS (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.30-1.46). When combined with a testosterone level of >10.3 nmol/L, a WBC count of ≥6.2 was associated with increased mortality (HR 2.96; 95% CI 1.45-6.06) when compared with a WBC count of <6.2 (p-interaction = 0.01). The HR for biochemical recurrence for patients with a testosterone level >10.3 nmol/L combined with a lymphocyte level above or equal to the median was nearly identical to the HR of a testosterone level >10.3 nmol/L with a WBC above or equal to the median. There was no association between testosterone level and the NLR.

CONCLUSIONS

A high WBC and lymphocyte count combined with normal testosterone levels increases the overall mortality of patients treated with radiotherapy for localized prostate cancer within the first 6-7 years post-treatment. Validation in larger cohorts is necessary.

The dynamic change of neutrophil to lymphocyte ratio can predict clinical outcome in stage I-III colon cancer

Whether the dynamic change of neutrophil to lymphocyte ratio (delta-NLR) can predict the outcome in various malignancies remained controversial. The delta-NLR has not been evaluated in colon cancer. Thus, we conducted the study to evaluate the predictive value of the delta-NLR in patients with colon cancer who underwent curative resection. Three-hundred and fifty-four patients with stage I-III colon cancer were retrospectively analysed. Clinicopathological features, preoperative NLR and postoperative NLR were collected. Prognostic factors were evaluated by univariate and multivariate analysis. The one, three and five-year overall survival rate in the delta-NLR < 0 group was 98.2%, 90.7% and 83.6%, respectively; and in the delta-NLR ≥ 0 group was 98.4%, 96.9% and 95.3%, respectively (log-rank test, P = 0.002). Univariate and multivariate analysis showed that there was a strong relationship between delta-NLR and overall survival. In conclusion, the delta-NLR was an independent prognostic factor for overall survival in early stage colon cancer. Patients with increased delta-NLR had an favourable clinical outcome.

Peripheral monocyte count: an independent diagnostic and prognostic biomarker for prostate cancer - a large Chinese cohort study

Increasing evidence indicates that inflammation may play important roles in tumorigenesis and progression, and an elevated peripheral monocyte count predicts a poor prognosis in various types of malignancies. Here, we evaluate the roles of peripheral monocyte count in the diagnosis and prognosis for prostate cancer in Chinese patients. A total of 1107 consecutive patients who had undergone prostate biopsy and 290 prostate cancer patients receiving androgen deprivation therapy as first-line therapy were retrospectively analyzed. The parameters were measured at the time of diagnosis. Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of a positive biopsy. Patients were categorized in two groups using a cutoff point of 0.425 × 10⁹ l⁻¹ as calculated by the receiver-operating curve analysis for prognosis. Univariate and multivariate Cox regression analyses were performed to determine the associations of monocyte count with progression-free survival, cancer-specific survival, and overall survival. Multivariate logistic regression analyses showed that monocyte count, age, prostate-specific antigen (PSA), free/total PSA, and prostate volume were independent predictors for prostate cancer. Multivariate Cox regression analyses identified an elevated monocyte count as an independent prognostic factor for worse cancer-specific survival (hazard ratio = 2.244, P < 0.05) and overall survival (hazard ratio = 1.995, P < 0.05), but not progression-free survival (P = 0.117). Our results indicated that an elevated monocyte count was an independent diagnostic biomarker for prostate cancer, and pretreatment peripheral monocyte count might play a significant role in the prognosis of prostate cancer patients treated with androgen deprivation therapy.

[Inflammatory and immune biomarkers of radiation response]

In radiotherapy, the treatment is adapted to each individual to protect healthy tissues but delivers most of time a standard dose according to the tumor histology and site. The only biomarkers studied to individualize the treatment are the HPV status with radiation dose de-escalation strategies, and tumor hypoxia with dose escalation to hypoxic subvolumes using FMISO- or FAZA-PET imaging. In the last decades, evidence has grown about the contribution of the immune system to radiation tumor response. Many preclinical studies have identified some of the mechanisms involved. In this context, we have realised a systematic review to highlight potential inflammatory and immune biomarkers of radiotherapy response. Some are inside the tumor microenvironment, as lymphocyte infiltration or PD-L1 expression, others are circulating biomarkers, including different types of hematological cells, cytokines and chemokines.

Baseline neutrophil-to-lymphocyte ratio predicts the prognosis of castration-resistant prostate cancer treated with abiraterone acetate

Abiraterone acetate (AA), a CYP17 inhibitor, now has a crucial role in the treatment of castration-resistant prostate cancer (CRPC), and previous studies have reported several prognostic clinical factors for AA treatment. The neutrophil-to-lymphocyte ratio (NLR) has also been investigated for a CRPC treatments in a few reports, however it has not been identified to be a prognostic factor for AA treatment in Japanese patients. The present study aimed to assess the association of the baseline NLR with the overall survival (OS) in CPRC patients treated by AA. The present study retrospectively reviewed a total of 90 consecutive patients with CRPC treated with AA from 2011 to 2016 at Yokohama City University Medical Center and National Cancer Center Hospital East. The primary endpoint of the study was the OS, which was defined as the survival from the start of AA administration. The secondary endpoint was the prostate-specific antigen (PSA) response. PSA response was defined as a reduction in antigen levels of >50%. Complete blood cell counts were performed, and the NLR was calculated using the neutrophil and lymphocyte counts obtained on the same day or a few days prior to the initiation of AA therapy. The NLR cut-off point was determined to be 3.76 for the OS, and divided into the high NLR group of 34 patients and the low NLR group of 56 patients. A PSA response was obtained in 8 patients (23.5%) in the high NLR group and in 24 (42.9%) in the low NLR group. The difference of PSA response between the two groups was significant (P=0.037). Kaplan-Meier curves demonstrated that a high NLR [NLR ≥3.76; median OS: 8.4 months; 95% confidence interval (CI): 6.325-10.475 months] was correlated with a risk of mortality compared with a low NLR (NLR <3.76; median OS not reached). A multivariate analysis demonstrated that the NLR was an independent predictor for the OS (hazard ratio: 2.682; 95% CI: 1.143-6.293; P=0.023). The findings suggest that the NLR may be a useful novel biomarker for predicting the prognosis of CRPC patients treated with AA.

Albumin and Fibrinogen Combined Prognostic Grade Predicts Prognosis of Patients with Prostate Cancer

Background: The nutritional status and systemic inflammation are thought to be associated with outcome in multiple types of cancer. The objective of this study was to determine the prognostic value of pretreatment albumin and fibrinogen combined prognostic grade (AFPG) in prostate cancer (PCa). Methods: 462 prostate cancer patients who had undergone androgen deprivation therapy (ADT) as first-line therapy at four cencters were retrospectively analyzed. The serum albumin levels and plasma fibrinogen levels were measured at the time of diagnosis. The AFPG was calculated according to albumin and fibrinogen levels dichotomized by optimal cut-off values or clinical reference values. Univariate and multivariate cox regression analyses were performed to determine the associations of AFPG with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Prognostic accuracy was evaluated with the Harrell concordance index. Results: Multivariate analyses identified AFPG as an independent prognostic indicator for PFS, CSS and OS (each p < 0.01). According to optimal cut-off values, the addition of AFPG to the final models improved predictive accuracy for PFS, CSS and OS compared with the clinicopathological base models, which included Gleason score and incidence of metastasis. Moreover, AFPG according to optimal cut-off values was a better prognostic predictor than albumin levels alone or fibrinogen levels alone or AFPG according to clinical reference values. Conclusion: Decreased AFPG could predict a significantly poor prognosis in patients with PCa. Thus, we recommend adding AFPG according to optimal cut-off values to traditional prognostic model to improve the predictive accuracy.

The prognostic significance of postoperative neutrophil-to-lymphocyte ratio after radical prostatectomy for localized prostate cancer

Background

The pretreatment neutrophil-to-lymphocyte ratio has prognostic value after radical prostatectomy for treating localized prostate cancer. However, the use of postoperative neutrophil-to-lymphocyte ratio has not been evaluated in this population. We investigated the prognostic significance of early postoperative neutrophil-to-lymphocyte ratio after radical prostatectomy for prostate cancer.

Methods

We retrospectively reviewed clinical data from 2,302 patients with localized prostate cancer who underwent radical prostatectomy at our institution between years 2000 and 2010. Only patients with pre- and postoperative complete blood counts with differential results were included. Patients who received neoadjuvant or postoperative adjuvant treatment and those without adequate medical records were excluded. Kaplan-Meier analyses were performed to analyze biochemical recurrence-free survival and overall survival rates. Univariate and multivariate Cox regression models were used for each endpoint.

Results

Kaplan-Meier curves showed that high postoperative neutrophil-to-lymphocyte ratio (>3.5) was significantly associated with decreased biochemical recurrence-free survival (p = 0.009) and overall survival (p = 0.010). In the univariate and multivariate Cox regression analyses, high postoperative neutrophil-to-lymphocyte ratio was a significant predictor of biochemical recurrence (hazard ratio 1.270, p = 0.008) and overall survival (hazard ratio 1.437, p = 0.033).

Conclusions

Our results demonstrate that postoperative neutrophil-to-lymphocyte ratio is an independent factor for biochemical recurrence and overall survival in patients who underwent radical prostatectomy for prostate cancer. These findings suggest that neutrophil-to-lymphocyte ratio can be a potentially valuable tool for stratifying high-risk patients and facilitating choices of postoperative therapy in patients with prostate cancer.

Pretreatment antigen-specific immunity and regulation - association with subsequent immune response to anti-tumor DNA vaccination

BACKGROUND

Immunotherapies have demonstrated clinical benefit for many types of cancers, however many patients do not respond, and treatment-related adverse effects can be severe. Hence many efforts are underway to identify treatment predictive biomarkers. We have reported the results of two phase I trials using a DNA vaccine encoding prostatic acid phosphatase (PAP) in patients with biochemically recurrent prostate cancer. In both trials, persistent PAP-specific Th1 immunity developed in some patients, and this was associated with favorable changes in serum PSA kinetics. In the current study, we sought to determine if measures of antigen-specific or antigen non-specific immunity were present prior to treatment, and associated with subsequent immune response, to identify possible predictive immune biomarkers.

METHODS

Patients who developed persistent PAP-specific, IFNγ-secreting immune responses were defined as immune "responders." The frequency of peripheral T cell and B cell lymphocytes, natural killer cells, monocytes, dendritic cells, myeloid derived suppressor cells, and regulatory T cells were assessed by flow cytometry and clinical laboratory values. PAP-specific immune responses were evaluated by cytokine secretion in vitro, and by antigen-specific suppression of delayed-type hypersensitivity to a recall antigen in an in vivo SCID mouse model.

RESULTS

The frequency of peripheral blood cell types did not differ between the immune responder and non-responder groups. Non-responder patients tended to have higher PAP-specific IL-10 production pre-vaccination (p = 0.09). Responder patients had greater preexisting PAP-specific bystander regulatory responses that suppressed DTH to a recall antigen (p = 0.016).

CONCLUSIONS

While our study population was small (n = 38), these results suggest that different measures of antigen-specific tolerance or regulation might help predict immunological outcome from DNA vaccination. These will be prospectively evaluated in an ongoing randomized, phase II trial.

Clinical implications of pretreatment inflammatory biomarkers as independent prognostic indicators in prostate cancer

OBJECTIVES

Research on the relationship between inflammatory biomarkers and malignant tumors has become a hotspot. Many studies have demonstrated that neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) could act as independent prognostic indicators for several solid tumors. This study aimed to evaluate the clinical implications of pretreatment inflammatory biomarkers, including NLR, PLR, and RDW as independent prognostic indicators in prostate cancer (PCa).

METHODS

A total of 226 PCa patients who were diagnosed at our institution from 2011 to 2016 were analyzed retrospectively. We compared the clinicopathological features, survival curves, and prognosis of the PCa patients between the high and low groups according to the cutoffs of NLR, PLR, and RDW.

RESULTS

The pretreatment NLR, PLR, and RDW values were significantly higher in the patients with PCa than those in the controls (P<.05). Increased NLR and PLR values were significantly associated with high risk of progression, including higher Gleason scores, cell proliferation antigen 67 (Ki-67) indexes, and prostate-specific antigen (PSA) levels (P<.05), whereas an elevated RDW was only associated with an older age. An increased NLR was correlated with both overall survival (OS) (P=.025) and disease-free survival (DFS) (P=.017). In addition, a higher PLR only showed a significantly worse DFS (P=.040). Pretreatment NLR was an independent prognostic indicator of DFS.

CONCLUSIONS

The pretreatment NLR and PLR might be beneficial to predict the progression and prognosis of PCa. Furthermore, NLR was more effective than PLR acting as an independent prognostic indicator for PCa.

Prognostic value of inflammation in prostate cancer progression and response to therapeutic: a critical review

Prostate is an immune-competent organ normally populated by inflammatory cells. Prostatic inflammation origin can be multi-factorial and there are some emerging evidences on its possible role as a factor involved in prostate cancer (PC) pathogenesis and progression. This review critically analyzes the role of inflammation as a prognostic factor for progression and aggressiveness of PC. We verified the last 10 years literature data on the association between inflammation and PC aggressiveness, or PC response to therapies. Several studies tried to correlate different inflammatory factors with the aggressiveness and metastatization of PC; all data sustain the role of inflammation in PC progression but they also produce confusion to identify a reliable clinical prognostic marker. Data on patients submitted to radical prostatectomy (RP) showed that cases with marked intraprostatic tissue inflammation are associated with higher rate of biochemical progression; systemic inflammation markers appear to have a significant prognostic value. Analyzing data on patients submitted to radiotherapy (RT) emerges a significant association between high neuthrophil to lymphocyte ratio (NLR) and decreased progression free survival and overall survival; also plateled to lymphocyte ratio (PLR) and C-reactive protein (CRP) have been proposed as significant prognostic factors for progression and overall survival. In patients submitted to androgen deprivation therapy (ADT), inflammation may drive castration resistant PC (CRPC) development by activation of STAT3 in PC cells. NLR has been proposed as independent predictor of overall survival in CRPC submitted to chemotherapy. Most of data are focused on markers related to systemic inflammation such as NLR and CRP, more than specifically to chronic prostatic inflammation. The suggestion is that these inflammatory parameters, also if not specific for prostatic inflammation and possibly influenced by several factors other than PC, can integrate with established prognostic factors.

Platelet to lymphocyte ratio as an independent prognostic indicator for prostate cancer patients receiving androgen deprivation therapy

Background

Platelet to Lymphocyte ratio (PLR) is thought to be associated with a worse outcome in multiple types of cancer. However, the prognostic significance of PLR has not been investigated in the prostate cancer (PCa) patients receiving hormonal therapy. The objective of this study was to determine the prognostic value of PLR in PCa patients treated with androgen deprivation therapy (ADT).

Methods

Two-hundred-ninety prostate cancer patients who had undergone ADT as first-line therapy were retrospectively analyzed. The blood cell counts were performed at the time of diagnosis. PLR was calculated as the ratio of platelet count to lymphocyte count. Patients were categorized in two groups using a cut-off point of 117.58 as calculated by the receiver-operating curve analysis. Correlations between PLR and clinical characteristics were analyzed. Meanwhile, univariate and multivariate cox regression analyses were performed to determine the associations of PLR with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Prognostic accuracy was evaluated with the Harrell concordance index.

Results

The differences of age, serum prostate-specific antigen (PSA) level, Gleason score, risk stratification and incidence of metastasis between low PLR group (<117.58) and high PLR group (≥117.58) were not statistically significant (p > 0.05). Multivariate analyses identified PLR as an independent prognostic factor for PFS (hazard ratio (HR) = 1.581, p = 0.013), CSS (HR = 1.768, p = 0.037) and OS (HR = 1.650, p = 0.044). The addition of PLR to the final model improved predictive accuracy (c-index: 0.747, 0.801 and 0.768) for PFS, CSS and OS compared with the clinicopathological base model (c-index: 0.730, 0.778 and 0.746), which included Gleason score and incidence of metastasis.

Conclusions

PLR might play a significant role in the prognosis of PCa patients treated with ADT. Thus, we recommend adding PLR to traditional prognostic model to improve the predictive accuracy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2363-5) contains supplementary material, which is available to authorized users.

Prognostic significance of neutrophil-to-lymphocyte ratio in prostate cancer: evidence from 16,266 patients

This study was aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with prostate cancer (PCa). A meta-analysis including 14 publications (15 cohorts) with 16,266 patients was performed to evaluate the association between NLR and overall survival (OS), progression-free survival (PFS)/recurrence-free survival (RFS) in PCa using hazard ratio (HR) and 95% confidence intervals (95% CI). The combining data showed that increased NLR predict poor OS (HR = 1.38, 95%CI: 1.22–1.56) and PFS/RFS (HR = 1.24, 95%CI 1.05–1.46) in PCa. Stratified analysis by PCa type, sample size, ethnicity and NLR cut-off value revealed that NLR showed consistent prognostic value in metastatic castration-resistant prostate cancer (mCRPC) patients and predict poor PFS/RFS in Asians, but not in Caucasians. These statistical data suggested that increased NLR could predict poor prognosis in patients with PCa.

Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Prostate Cancer: A Systematic Review and Meta-analysis

Inflammation is increasingly reported to be associated with the prognosis of patients with cancers. And the prognostic role of neutrophil-to-lymphocyte ratio (NLR) in patients with prostate cancer (PCa) remains inconsistent. Therefore, we conducted this systematic review and meta-analysis to obtain a more reliable assessment of prognostic significance of NLR in PCa.A comprehensive literature research regarding the association of NLR and prognosis of PCa was performed through PubMed, Embase, Cochrane Central, and Web of Science. The hazard ratios (HRs) and its 95% confidence intervals (CIs) for overall survival (OS), progression-free survival, or recurrence-free survival were extracted and pooled using fix-effects model or random-effects model.A total of 14 studies that met our criterion were included in this meta-analysis. Our pooled results demonstrated that elevated NLR was not significantly associated with the poor OS (HR = 1.45; 95% CI 0.77-2.71; P = 0.248) or recurrence-free survival (HR = 1.34; 95% CI 0.89-2.02; P = 0.155) of patients with localized PCa. Although elevated NLR predicted poorer OS (HR = 1.57; 95% CI 1.41-1.74; P < 0.001) and progression-free survival (HR = 1.97; 95% CI 1.28-3.04; P = 0.002) of patients with metastatic castration resistant prostate cancer (mCRPC).Elevated NLR is a strong indicator of poorer prognosis of patients with mCRPC, whereas the NLR is not significantly associated with prognosis of patients with localized PCa. Therefore, NLR could be used in patients with mCRPC for risk stratification and decision making of individual treatment.

Evaluation of neutrophil-to-lymphocyte ratio prior to prostate biopsy to predict biopsy histology: Results of 1836 patients

INTRODUCTION

We evaluate the role of NLR prior to prostate biopsy to predict biopsy histology and Gleason score in patients with prostate cancer.

METHODS

In this retrospective study, we evaluated data of patients underwent prostate biopsy between May 2005 and March 2015. We collected the following data: age, prostate-specific antigen (PSA), biopsy histology, Gleason score (GS) in prostate cancer patients, neutrophil counts, and lymphocyte counts. Patients were grouped as benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. The Chi square test was used to compare categorical variables and analysis of variance (ANOVA) was applied for continuous variables.

RESULTS

Data of 1836 patients were investigated. The mean age, total PSA and neutrophil-lymphocyte ratio (NLR) of the population were 66.8 ± 8.17 years, 9.38 ± 4.7 ng/dL, and 3.11 ± 1.71, respectively. Patients were divided as follows: 625 in the group with BPH history, 600 in the prostatitis group, and 611 in the prostate cancer histology group. The mean NLR of the prostatitis group was higher compared to the prostate cancer and BPH groups (p = 0.0001). The mean NLR of the prostate cancer group was significantly higher compared to the BPH group (p = 0.002). The GS 8-10 group had a significantly higher mean NLR compared to GS 5-6 (3.64 vs. 2.54, p = 0.0001) and GS 7 (3.64 vs. 2.58, p = 0.0001) patients.

CONCLUSIONS

NLR was found to differ with regard to histology of prostate biopsy and higher GS was associated with higher NLR in patients with prostate cancer. However prostatitis prevents the use of NLR in predicting prostate cancer before a prostate biopsy. Also, the retrospective nature and lack of multivariate analysis in this study somewhat limits the relevance of these results.

High preoperative neutrophil-lymphocyte ratio predicts biochemical recurrence in patients with localized prostate cancer after radical prostatectomy

PURPOSE

To investigate the association between preoperative neutrophil-lymphocyte ratio (NLR) and oncological outcomes in patients with localized prostate cancer (PCa) after radical prostatectomy (RP).

METHODS

We retrospectively reviewed the records of 1367 patients who underwent RP between November 2003 and April 2012. Patients who underwent a concurrent biopsy/procedure in other organs, had evidence of acute infection, or had systemic inflammatory disease were excluded. We divided the patients by NLR level and analyzed their perioperative outcomes. To determine NLR significance, we performed a multivariate logistic regression analysis of the pathological adverse outcomes and a Cox proportional hazard analysis of the biochemical recurrence (BCR), which was defined as a prostate-specific antigen level ≥0.2 ng/mL on two consecutive tests.

RESULTS

Among the 1367 patients, 158 (11.6 %) in the high-NLR (≥2.5) group had a higher biopsy Gleason score (p < 0.001), pathological Gleason score (p < 0.001), and pathological stage (p < 0.001) than patients in the low-NLR (<2.5) group (n = 1209, 88.4 %). Multivariate analysis revealed that high NLR was significantly correlated with adverse pathological outcomes of higher pathological stage (HR 1.688; 95 % CI 1.142-2.497; p = 0.009) and extracapsular extension (HR 1.698; 95 % CI 1.146-2.516; p = 0.008). Kaplan-Meier analysis showed significantly worse BCR-free survival (p < 0.001) in patients with a high NLR. A high NLR was a significant predictor of BCR after RP (HR 1.358; 95 % CI 1.008-1.829; p = 0.044).

CONCLUSIONS

High NLR was significantly related to unfavorable clinicopathological outcomes and worse BCR-free survival. Further studies are needed to clarify the correlation between NLR and PCa.