1
|
Murray NP, Fuentealba C, Reyes E, Lopez MA, Salazar A, Minzer S, Munoz L, Orrego S, Guzman E, Arzeno L. 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. Asian Pac J Cancer Prev 2019; 20:3385-3389. [PMID: 31759363 PMCID: PMC7062991 DOI: 10.31557/apjcp.2019.20.11.3385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Indexed: 12/09/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Nigel P Murray
- Consultant in Hematology, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile.,Professor Hematology and Head CTC Unit, Faculty of Medicine, University Finis Terrae, Av Pedro de Valdivia, Providencia, Santiago, Chile
| | - Cynthia Fuentealba
- Consultant Urologist, Department of Urology, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Eduardo Reyes
- Consultant Urologist, Department of Urology, Hospital DIPRECA, Vital Apoquindo 1200, Las Condes, Santiago, Chile.,Faculty of Medicine, University Diego Portales, Manuel Rodríguez Sur 415, Santiago, Chile
| | - Marco Antonio Lopez
- Physican General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Anibal Salazar
- Consultant Urologist, Department of Urology, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Simona Minzer
- Physican General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Lorena Munoz
- Consultant Internal Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile
| | - Shenda Orrego
- Physican General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Eghon Guzman
- Physican General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar, Ñuñoa, Santiago, Chile
| | - Lucas Arzeno
- Tutor, Faculty of Medicine, University Mayor, San Pio X 2245, Providencia, Santiago, Chile
| |
Collapse
|
2
|
Adhyatma KP, Prapiska FF, Siregar GP, Warli SM. Systemic Inflammatory Response in Predicting Prostate Cancer: The Diagnostic Value of Neutrophil-To-Lymphocyte Ratio. Open Access Maced J Med Sci 2019; 7:1628-1630. [PMID: 31210812 PMCID: PMC6560303 DOI: 10.3889/oamjms.2019.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Over the past decades, the study of the microenvironment of cancer has supported the hypothesis between inflammation and cancer. Previous studies have demonstrated a promising value of platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory response in prostate cancer. AIM To evaluate their pre-biopsy values of PLR and NLR in predicting prostate cancer. MATERIAL AND METHODS This is a diagnostic study with retrospective design. We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostate biopsy in Adam Malik Hospital between August 2011 and August 2015. We used PSA value above 4 ng/dL as the threshold for the biopsy candidates. The relationship between pre-biopsy variables affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and estimated prostate volume (EPV). The PLR and NLR were calculated from the ratio of related platelets or absolute neutrophil counts with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa. RESULTS Out of 298 patients included in this study, we defined two groups consist of 126 (42.3%) BPH and 172 PCa (57.7%) patients. Mean age for both groups are 66.36 ± 7.53 and 67.99 ± 7.48 years old (p = 0.64), respectively. There are statistically significant differences noted from both BPH and PCa groups in terms of PSA (19.28 ± 27.11 ng/dL vs 40.19 ± 49.39 ng/dL), EPV (49.39 ± 23.51 cc vs 58.10 ± 30.54 cc), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both BPH and PCa groups respectively (p < 0.05). A Receiver Operating Characteristics (ROC) analysis was performed for PLR and NLR in analysing their value in predicting prostate cancer. The Area Under the Curve (AUC) of PLR is 57.9% with a sensitivity of 56.4% and specificity of 55.6% in the cut-off point of 143 (p = 0.02). The NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. These AUCs were comparable with the AUC of PSA alone (68.5%). We performed logistic regression between PSA, PLR, and NLR with result in the exclusion of PLR if calculated conjunctively. Therefore, NLR has a promising performance in predicting PCa in patients with PSA above 4 ng/dL (OR = 3.2; 95%CI: 1.96-5.11). We found as many as 80 (63.5%) patients with benign biopsy results with negative NLR value in this study. CONCLUSION NLR has promising value in predicting prostate cancer. A further prospective study in validating its diagnostic value was needed.
Collapse
Affiliation(s)
- Kharisma Prasetya Adhyatma
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| | - Fauriski F Prapiska
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| | - Syah Mirsya Warli
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| |
Collapse
|
3
|
Hashimoto M, Matsumura N, Ohzeki T, Hongo S, Sugimoto K, Shimizu N, Mori Y, Minami T, Nozawa M, Nose K, Tahara H, Yoshimura K, Uemura H. The Change in Neutrophil Lymphocyte Ratio from the First to the Last Repeat Prostate Biopsy Proposed as a Marker of Carcinogenesis. Urol Int 2018; 101:74-79. [PMID: 29909414 DOI: 10.1159/000489400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/18/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We investigated whether the change in the neutrophil lymphocyte ratio (NLR) from the first to the last repeat prostate biopsy (ΔNLR) could be the diagnostic tool or not for prostate cancer (PCa) detection. MATERIALS AND METHODS We retrospectively evaluated medical records of men who had undergone repeat prostate biopsy. The investigated parameters were white blood cell, neutrophil, lymphocyte counts, NLR at the last prostate biopsy, ΔNLR, prostate-specific antigen (PSA), PSA density (PSAD), and PSA velocity. Exclusion criteria were the presence of cancers other than prostate origin, medication, and diseases which induce the change of NLR. RESULTS A total of 301 men who had undergone repeat prostate biopsy were selected for this study. After applying exclusion criteria, 223 patients were included. Of these patients, 94 were diagnosed with PCa (Group I) and 129 with no malignancy (Group II). Only a single patient had metastasis. On evaluating the area under the receiver operating characteristic curve of all study parameters, ΔNLR was the most accurate marker, followed by PSAD and then NLR measured at the last biopsy. CONCLUSIONS ΔNLR was the most accurate marker to improve the total predictive value in repeat prostate biopsy for diagnosing PCa.
Collapse
Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoki Matsumura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takayuki Ohzeki
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Sachiko Hongo
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Koichi Sugimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Nobutaka Shimizu
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasunori Mori
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masahiro Nozawa
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiro Nose
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Hideo Tahara
- Department of Urology, Mimihara General Hospital, Sakai, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| |
Collapse
|
4
|
Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Castration-Resistant Prostate Cancer Patients Who Received Cabazitaxel Chemotherapy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7538647. [PMID: 28948170 PMCID: PMC5602619 DOI: 10.1155/2017/7538647] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/30/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES An elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be associated with a poor prognosis in several cancers. We evaluated the utility of an elevated NLR as a biomarker to predict the prognosis of metastatic castration-resistant prostate cancer (mCRPC) patients treated with cabazitaxel (CBZ). METHODS We analyzed 47 patients who received CBZ chemotherapy for mCRPC in our institutions. The NLR was calculated using the neutrophil and lymphocyte counts before CBZ chemotherapy. We determined the NLR cut-off value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. A multivariate analysis was performed to investigate the association between the NLR and the prognosis. RESULTS The median overall survival (OS) after CBZ was 10.0 months (range: 6.3-13.2). The median OS was shorter in patients with a high NLR (≥3.83) than in those with a low NLR (<3.83) (5.8 versus 13.2 months, p = 0.018). In the multivariate analysis, the NLR, patient age, and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.01, p = 0.030; hazard ratio 3.10, p = 0.029; hazard ratio 12.38, p = 0.001, resp.). CONCLUSIONS NLR might be a useful prognostic biomarker in mCRPC patients treated with CBZ.
Collapse
|
5
|
Gürağaç A, Demirer Z. The neutrophil-to-lymphocyte ratio in clinical practice. Can Urol Assoc J 2016; 10:141. [PMID: 27217863 DOI: 10.5489/cuaj.3587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ali Gürağaç
- Tatvan Military Hospital, Department of Urology, Bitlis, Turkey
| | - Zafer Demirer
- Eskisehir Military Hospital, Department of Urology, Eskisehir, Turkey
| |
Collapse
|