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Kayar R, Tokuc E, Ozsoy E, Demir S, Kayar K, Topaktas R, Demir S, Ozturk M. The predictive impact of hematological inflammatory markers in detecting prostate cancer in patients with PI-RADS 3 lesions on multiparametric magnetic resonance imaging. Prostate 2024; 84:1244-1250. [PMID: 38926140 DOI: 10.1002/pros.24762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The diagnostic accuracy of suspicious lesions that are classified as PI-RADS 3 in multiparametric prostate magnetic-resonance imaging (mpMRI) is controversial. This study aims to assess the predictive capacity of hematological inflammatory markers such as neutrophil-lymphocyte ratio (NLR), pan-immune-inflammation value (PIV), and systemic immune-response index (SIRI) in detecting prostate cancer in PI-RADS 3 lesions. METHODS 276 patients who underwent mpMRI and subsequent prostate biopsy after PI-RADS 3 lesion detection were included in the study. According to the biopsy results, the patients were distributed to two groups as prostate cancer (PCa) and no cancer (non-PCa). Data concerning age, PSA, prostate volume, PSA density, PI-RADS 3 lesion size, prostate biopsy results, monocyte counts (109/L), lymphocyte counts (109/L), platelet counts (109/L), neutrophils count (109/L) were recorded from the complete blood count. From these data; PIV value is obtained by monocyte × neutrophil × platelet/lymphocyte, NLR by neutrophil/lymphocyte, and SIRI by monocyte number × NLR. RESULTS Significant variations in neutrophil, lymphocyte, and monocyte levels between PCa and non-PCa patient groups were detected (p = 0.009, p = 0.001, p = 0.005 respectively, p < 0.05). NLR, PIV, and SIRI exhibited significant differences, with higher values in PCa patients (p = 0.004, p = 0.001, p < 0.001 respectively, p < 0.05). The area under curve of SIRI was 0.729, with a cut-off value of 1.20 and with a sensitivity 57.70%, and a specificity of 68.70%. CONCLUSION SIRI outperformed NLR and PIV in detecting PCa in PI-RADS 3 lesions, showcasing its potential as a valuable biomarker. Implementation of this parameter to possible future nomograms has the potential to individualize and risk-stratify the patients in prostate biopsy decision.
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Affiliation(s)
- Ridvan Kayar
- Department of Urology, Van Training and Research Hospital, University of Health Sciences, Van, Turkiye
| | - Emre Tokuc
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Istanbul, Turkiye
| | - Emrah Ozsoy
- Unye Private Cakirtepe Hospital, Urology Clinic, Ordu, Turkiye
| | - Samet Demir
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Istanbul, Turkiye
| | - Kemal Kayar
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Istanbul, Turkiye
| | - Ramazan Topaktas
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Istanbul, Turkiye
| | - Selamettin Demir
- Department of Urology, Van Training and Research Hospital, University of Health Sciences, Van, Turkiye
| | - Metin Ozturk
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Istanbul, Turkiye
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Tamas F, Tamas CI, Suciu BA, Manu DR, Cehan AR, Balasa AF. Comparative Analysis of Inflammatory Indexes in Lung Cancer Patients With and Without Brain Metastases. Cureus 2024; 16:e60921. [PMID: 38910770 PMCID: PMC11193412 DOI: 10.7759/cureus.60921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Lung cancer is the leading cause of oncological deaths worldwide. Various combined inflammatory indexes, such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have shown associations with pretreatment survival prognosis in patients suffering of lung cancer with or without brain metastases. This study aimed to compare the average values of NLR, PLR, LMR, and SII in healthy patients, patients with lung cancer without any other metastases, and patients with lung cancer and brain metastases. Materials and methods In this prospective study, we have divided the patients into three groups: Group 1 included patients diagnosed with lung cancer and one or more brain metastases of lung cancer origin, Group 2 included patients diagnosed with lung cancer without known metastases, and Group 3 was the control group which included healthy subjects. Preoperative complete blood counts were extracted for all included patients and we calculated the values of SII, NLR, PLR, and LMR for each individual patient in each group. The next step was to calculate the average values of SII, NLR, PLR, and LMR for each group of patients and to identify the differences between groups. Results A total number of 228 patients were enrolled in the study. Group 1 included 67 patients with average values of SII = 2020.98, NLR = 7.25, PLR = 199.46, and LMR = 2.97. Group 2 included 88 patients with average values of SII = 1638.01, NLR = 4.58, PLR = 188.42, and LMR = 3.43. Group 3 included 73 subjects with the following average values of the inflammatory indexes: SII = 577.41, NLR = 2.34, PLR = 117.84, and LMR = 3.56. Conclusion We observed statistically significant differences in SII, NLR, and PLR among the three groups of patients, suggesting their potential role as prognostic markers. Furthermore, our analysis revealed significant correlations between inflammatory markers within lung cancer patients, highlighting their involvement in tumor microenvironment modulation. Our findings demonstrate an escalation in SII, NLR, and PLR values as the disease progresses. These parameters of inflammation and immune status are readily and cost-effectively, and repeatedly assessable in routine clinical practice.
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Affiliation(s)
- Flaviu Tamas
- Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, ROU
- Neurosurgery, Emergency Clinical County Hospital, Târgu Mureș, Târgu Mureș, ROU
| | - Corina I Tamas
- Neurosurgery, Emergency Clinical County Hospital, Târgu Mureș, Târgu Mureș, ROU
- Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Bogdan A Suciu
- Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, ROU
- Thoracic Surgery, Emergency Clinical County Hospital, Târgu Mureș, Târgu Mureș, ROU
| | - Doina R Manu
- Biological Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Alina R Cehan
- Plastic and Reconstructive Surgery, Emergency Clinical County Hospital, Târgu Mureș, Târgu Mureș, ROU
| | - Adrian F Balasa
- Neurosurgery, Emergency Clinical County Hospital, Târgu Mureș, Târgu Mureș, ROU
- Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, ROU
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Baylan B, Ulusoy K, Ekenci B, Kartal IG. Can systemic immune-inflammation index and hematologic parameters aid in decision-making for active surveillance or curative treatment in low-risk prostate cancer? Asian J Surg 2024; 47:1360-1365. [PMID: 38065745 DOI: 10.1016/j.asjsur.2023.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Pathologic Gleason Score (GS) upgrading is common in patients with low-risk localized prostate cancer (PCa) who are followed by active surveillance (AS) or undergo radical prostatectomy (RP). This fact raises concerns about inadequate treatment, especially in AS patients. We aimed to analyze the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation (SII) index with GS upgrading. MATERIALS AND METHODS This study was approved by the Ethical Review Committee of Afyonkarahisar Health Sciences University. Data of the patients who underwent RP for PCa at three different centers between 2018 and 2023 were retrospectively analyzed. The patients were divided into 2 groups based on GR upgrading status as "upgrading" and "non-upgrading". Among the patients who underwent RP, 77 patients who fully met the criteria for AS were identified. The patients eligible for AS were divided into "non-upgrading" and "upgrading" groups. These groups were compared regarding NLR, PLR, and SII index values. RESULTS Overall, data from 250 patients were reviewed. Among these, 147 had GS upgrading, while 103 had no upgrading. Seventy-seven patients were eligible for AS. Among these patients, 30 had upgrading, while 47 were in the "non-upgrading" group. Our analysis revealed that an NLR of 1.85 and above was associated with a 2.238-fold increase in the risk of GS upgrading (p = 0.009). Also, a PLR of 115.7 and above was affiliated with a 2.992-fold increase in the GS upgrading risk (p < 0.001). The analysis regarding patients who underwent RP but were eligible for AS revealed that an NLR of ≥1.68 was associated with a 3.25-fold risk increase in GS upgrading. On the other hand, a PLR≥134.5 and an SII index≥630.7 were affiliated with a 12.303-fold and 6.562-fold increase in the risk of upgrading (p = 0.019, p = 0.018). CONCLUSION The decision of AS should be carefully reappraised, and treatment methods such as RP or radiotherapy should be considered in patients with high NLR, PLR, or SII index values.
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Affiliation(s)
- Burhan Baylan
- Afyonkarahisar Health Sciences University Department of Urology, Afyonkarahisar, Turkiye.
| | - Kemal Ulusoy
- Afyonkarahisar Health Sciences University Department of Urology, Afyonkarahisar, Turkiye.
| | - Berk Ekenci
- Department of Urology, Health Sciences University Diskapi Training and Research Hospital, Ankara, Turkiye.
| | - Ibrahim Guven Kartal
- Kutahya Health Scıences Unıversıty Evlıya Çelebı Traınıng and Research Hospıtal Department of Urology, Kutahya, Turkiye.
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Gibellini L, Borella R, Santacroce E, Serattini E, Boraldi F, Quaglino D, Aramini B, De Biasi S, Cossarizza A. Circulating and Tumor-Associated Neutrophils in the Era of Immune Checkpoint Inhibitors: Dynamics, Phenotypes, Metabolism, and Functions. Cancers (Basel) 2023; 15:3327. [PMID: 37444436 DOI: 10.3390/cancers15133327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Neutrophils are the most abundant myeloid cells in the blood and are a considerable immunological component of the tumor microenvironment. However, their functional importance has often been ignored, as they have always been considered a mono-dimensional population of terminally differentiated, short-living cells. During the last decade, the use of cutting-edge, single-cell technologies has revolutionized the classical view of these cells, unmasking their phenotypic and functional heterogeneity. In this review, we summarize the emerging concepts in the field of neutrophils in cancer, by reviewing the recent literature on the heterogeneity of both circulating neutrophils and tumor-associated neutrophils, as well as their possible significance in tumor prognosis and resistance to immune checkpoint inhibitors.
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Affiliation(s)
- Lara Gibellini
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Rebecca Borella
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Elena Santacroce
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Eugenia Serattini
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Federica Boraldi
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Daniela Quaglino
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences (DIMEC), University Hospital GB Morgagni-L Pierantoni, 47121 Forlì, Italy
| | - Sara De Biasi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
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Nepal SP, Nakasato T, Fukagai T, Ogawa Y, Nakagami Y, Shichijo T, Morita J, Maeda Y, Oshinomi K, Unoki T, Noguchi T, Inoue T, Kato R, Amano S, Mizunuma M, Kurokawa M, Tsunokawa Y, Yasuda S. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios alone or combined with prostate-specific antigen for the diagnosis of prostate cancer and clinically significant prostate cancer. Asian J Urol 2023; 10:158-165. [PMID: 36942115 PMCID: PMC10023529 DOI: 10.1016/j.ajur.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/21/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022] Open
Abstract
Objective We evaluated whether the blood parameters before prostate biopsy can diagnose prostate cancer (PCa) and clinically significant PCa (Gleason score [GS] ≥7) in our hospital. Methods This study included patients with increased prostate-specific antigen (PSA) up to 20 ng/mL. The associations of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) alone or with PSA with PCa and clinically significant PCa were analyzed. Results We included 365 patients, of whom 52.9% (193) had PCa including 66.8% (129) with GS of ≥7. PSA density (PSAD) and PSA had better the area under the curve (AUC) of 0.722 and 0.585, respectively with p=0.001 for detecting PCa compared with other blood parameters. PSA combined with PLR (PsPLR) and PSA with NLR (PsNLR) had better AUC of 0.608 and 0.610, respectively with p<0.05, for diagnosing GS≥7 population, compared with PSA, free/total PSA, NLR, PLR, and PsNPLR (PSA combined with NLR and PLR). NLR and PLR did not predict PCa on multivariate analysis. For GS≥7 cancer detection, in the multivariate analysis, separate models with PSA and NLR (Model 1: PsNLR+baseline parameters) or PSA and PLR (Moder 2: PsPLR+baseline parameters) were made. Baseline parameters comprised age, digital rectal exam-positive lesions, PSA density, free/total PSA, and magnetic resonance imaging. Model 2 containing PsPLR was statistically significant (odds ratio: 2.862, 95% confidence interval: 1.174-6.975, p=0.021) in finding aggressive PCa. The predictive accuracy of Model 2 was increased (AUC: 0.734, p<0.001) than that when only baseline parameters were used (AUC: 0.693, p<0.001). Conclusion NLR or PLR, either alone or combined with PSA, did not detect PCa. However, the combined use of PSA with PLR could find the differences between clinically significant and insignificant PCa in our retrospective study limited by the small number of samples.
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Wang S, Ji Y, Ma J, Du P, Cao Y, Yang X, Yu Z, Yang Y. Role of inflammatory factors in prediction of Gleason score and its upgrading in localized prostate cancer patients after radical prostatectomy. Front Oncol 2023; 12:1079622. [PMID: 36713540 PMCID: PMC9878388 DOI: 10.3389/fonc.2022.1079622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the role of inflammatory factors including systemic immune-inflammation index (SII) and neutrophil to lymphocyte ratio (NLR) in predicting Gleason Score (GS) and Gleason Score upgrading (GSU) in localized prostate cancer (PCa) after radical prostatectomy (RP). Methods The data of 297 patients who underwent prostate biopsy and RP in our center from January 2014 to March 2020 were retrospectively analyzed. Preoperative clinical characteristics including age, values of tPSA, total prostate volume (TPV), f/t PSA ratio, body mass index (BMI), biopsy GS and inflammatory factors including SII, NLR, lymphocyte to monocyte (LMR), neutrophil ratio (NR), platelet to lymphocyte ratio (PLR), lymphocyte ratio (LR), mean platelet volume (MPV) and red cell distribution (RDW) as well as pathological T (pT) stage were collected and compared according to the grades of RP GS (GS ≤ 6 and GS≥7), respectively. ROC curve analysis was used to confirm the discriminative ability of inflammatory factors including SII, NLR and their combination with tPSA for predicting GS and GSU. By using univariate and multivariate logistic regression analysis, the association between significant inflammatory markers and grades of GS were evaluated. Results Patients enrolled were divided into low (GS ≤ 6) and high (GS≥7) groups by the grades of GS. The median values of clinical factors were 66.08 ± 6.04 years for age, 36.62 ± 23.15 mL for TPV, 26.16 ± 33.59 ng/mL for tPSA and 0.15 ± 0.25 for f/t PSA ratio, 22.34 ± 3.14 kg/m2 for BMI, 15 (5.1%) were pT1, 116 (39.1%) were pT2 and 166 (55.9%) were pT3. According to the student's t test, patients in high GS group had a greater proportion of patients with pT3 (P<0.001), and higher NLR (P=0.04), SII (P=0.037) and tPSA (P=0.015) compared with low GS group, the distribution of age, TPV, f/t PSA ratio, BMI, LMR, NR, PLR, LR, MPV and RDW did not show any significantly statistical differences. The AUC for SII, NLR and tPSA was 0.732 (P=0.007), 0.649 (P=0.045) and 0.711 (P=0.015), with threshold values of 51l.08, 2.3 and 10.31ng/mL, respectively. According to the multivariable logistic regression models, NLR ≥ 2.3 (OR, 2.463; 95% CI, 0.679-10.469, P=0.042), SII ≥ 511.08 (OR, 3.519; 95% CI 0.891-12.488; P=0.003) and tPSA ≥ 10.31 ng/mL (OR, 4.146; 95% CI, 1.12-15.35; P=0.033) were all independent risk factors associated with higher GS. The AUC for combination of SII, NLR with tPSA was 0.758 (P=0.003) and 0.756 (P=0.003), respectively. GSU was observed in a total of 48 patients with GS ≤ 6 (55.17%). Then patients were divided into 2 groups (high and low) according to the threshold value of SII, NLR, tPSA, SII+tPSA and NLR+tPSA, respectively, when the GSU rates were compared with regard to these factors, GSU rate in high level group was significantly higher than that in low level group, P=0.001, 0.044, 0.017, <0.001 and <0.001, respectively. Conclusion High SII, NLR and tPSA were associated with higher GS and higher GSU rate. SII was likely to be a more favorable biomarker for it had the largest AUC area compared with tPSA and NLR; the combination of SII or NLR with tPSA had greater values for predicting GS and GSU compared with NLR, SII or tPSA alone, since the AUC area of combination was much higher. SII, NLR were all useful inflammatory biomarkers for predicting GS and detecting GSU among localized PCa patients with biopsy GS ≤ 6.
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Jethwani DL, Sivamoorthy LL, Toh CC, Malek R. Predicting the diagnosis of prostate cancer with a scoring system based on novel biomarkers. BMC Urol 2022; 22:13. [PMID: 35109827 PMCID: PMC8808971 DOI: 10.1186/s12894-022-00956-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/12/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Charng Chee Toh
- Department of Urology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Rohan Malek
- Department of Urology, Hospital Selayang, Batu Caves, Selangor, Malaysia
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Wang C, Zhang Y, Gao WQ. The evolving role of immune cells in prostate cancer. Cancer Lett 2022; 525:9-21. [PMID: 34715253 DOI: 10.1016/j.canlet.2021.10.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022]
Abstract
Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death among men in western countries. Androgen deprivation therapy (ADT) is considered the standard therapy for recurrent prostate cancer; however, this therapy may lead to ADT resistance and tumor progression, which seems to be regulated by epithelial-mesenchymal transition (EMT) and/or neuroendocrine differentiation (NED). In addition, recent data suggested the involvement of either adaptive or innate infiltrated immune cells in the initiation, progression, metastasis, and treatment of prostate cancer. In this review, we outlined the characteristics and roles of these immune cells in the initiation, progression, metastasis, and treatments of prostate cancer. We also summarized the current therapeutic strategies in targeting immune cells of the prostate tumor microenvironment.
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Affiliation(s)
- Chao Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Yan Zhang
- State Key Laboratory of Oncogenes and Related Genes, Renji-MedX Stem Cell Research Center, Ren Ji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China; Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China.
| | - Wei-Qiang Gao
- State Key Laboratory of Oncogenes and Related Genes, Renji-MedX Stem Cell Research Center, Ren Ji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China; Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China.
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Du J, Lim EJ, Huang HH, Lau WKO. Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of early prostate cancer among men who underwent robotic transperineal prostate biopsy. Medicine (Baltimore) 2021; 100:e28007. [PMID: 34918651 PMCID: PMC8678015 DOI: 10.1097/md.0000000000028007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the predicted value of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of early prostate cancer by using standardized Full blood count (FBC) performed within 4 weeks before biopsy and histology results from transperineal prostate biopsy (RTPB).Patients who underwent RTPB under general anesthesia (GA), at Urology Department, Singapore General Hospital between September 2006 and Febuary 2016 were retrospectively reviewed.NLR was calculated using full blood count (FBC) that was done as a pre-admission test before GA within 4 weeks before the biopsy. Statistical analyses were done to establish the correlation of NLR and different clinical parameters such as biopsy histology, pre-biopsy PSA, and prostate volume.A total of 652 patients who underwent RTPB for diagnostic purposes with a valid PSA level were included in this study. There was total of 409 (62.7%) benign histology and 243 (37.3%) prostate cancer. There was no significant difference in median NLR between the benign and prostate cancer group (2.00 vs 1.99; P = .29).In the subgroups analysis, there was also no significant difference of median NLR value in clinical significant cancer (defined as Gleason 3 + 4 and above) and benign histology group (NLR 2.00 vs 2.01, P = .41), as well as prostate cancer and benign group according to different pre-biopsy PSA levels: PSA (ug/l) < 4, 4 to 10, 10 to 20, and >20, respectively. (Median NLR 1.34 vs 1.76; 1.97 vs 1.97; 1.97 vs 2.18; 2.18 vs 1.98, P > .05). NLR is neither associated with prostate cancer using logestic regression model nor a strong predictor of the Gleason grade group and D'Amico risk stratification group using ordinal regression model. (P > .05)There was no statistically significant difference of NLR between the benign and prostate cancer group as a whole or in the subgroup analyses for patients who underwent robotic transperineal prostate biopsy. NLR may have a limited role in predicting early-stage prostate cancer.
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Xu Z, Zhang J, Zhong Y, Mai Y, Huang D, Wei W, Huang J, Zhao P, Lin F, Jin J. Predictive value of the monocyte-to-lymphocyte ratio in the diagnosis of prostate cancer. Medicine (Baltimore) 2021; 100:e27244. [PMID: 34559125 PMCID: PMC8462614 DOI: 10.1097/md.0000000000027244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/25/2021] [Indexed: 01/05/2023] Open
Abstract
It has been reported that inflammation and immune system are related to prostate cancer. The neutrophil-to-lymphocyte ratio (NLR), as well as the platelet-to-lymphocyte ratio (PLR), have already been proposed as new indices to help diagnose prostate cancer (PCa). However, the monocyte-to-lymphocyte ratio (MLR) with regard to PCa has rarely been mentioned.To investigate the capability of the MLR to predict PCa.Patients who were pathologically diagnosed with PCa in our hospital and healthy control subjects who conformed to the inclusion criteria were enrolled. Patient data were recorded, including age, complete blood counts, blood biochemistry, and serum prostate-specific antigen (PSA) levels. The differences in these data between the groups were analyzed and the diagnostic value of the MLR was compared with PSA.Our study included a total of 100 patients with PCa and 103 healthy control subjects. Patients with PCa presented with a significantly higher NLR, MLR, and PLR compared to control subjects. However, the hemoglobin and lymphocyte levels were lower (P < .05) in PCa patients. The area under the curve (AUC) of PSA and ratio of free/total serum prostate-specific antigen were 0.899 (95% confidence interval [CI]: 0.857-0.942) and 0.872 (95% CI: 0.818-0.926), respectively, while the AUC of the MLR was 0.852 (95% CI: 0.798-0.906), which was higher than that of the NLR, PLR, and any other blood parameters. Additionally, the optimal cut-off value of the MLR for PCa was 0.264, with a specificity of 87.4% and a sensitivity of 72.0%. An evaluation of the diagnostic value of MLR + PSA gave an AUC of 0.936 (95% CI: 0.902-0.970). However, the AUC of MLR + PSA + f/tPSA was 0.996 (95% CI: 0.991-1.000). The diagnostic value of MLR + NLR + PSA gave an AUC of 0.945 (95% CI: 0.913-0.977), and the specificity is 0.971.PSA remains the most important diagnostic indicator. MLR combined with PSA and f/tPSA has the higher predictive value than PSA. It suggests that MLR may be another good predictive indicator of PCa. It can help reduce the clinical false positive rate.
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Affiliation(s)
- Zhanping Xu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Jing Zhang
- Department of Gynecology, Family Planning Research Institute of Guangdong Province, Guangzhou, Guangdong, PR China
| | - Yuxiang Zhong
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Yuan Mai
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Danxuan Huang
- Health Management Center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Wei Wei
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Jianhua Huang
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Pengpeng Zhao
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Fuxiang Lin
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
| | - Jingmiao Jin
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, PR China
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11
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Novel Prostate Cancer Biomarkers: Aetiology, Clinical Performance and Sensing Applications. CHEMOSENSORS 2021. [DOI: 10.3390/chemosensors9080205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The review initially provides a short introduction to prostate cancer (PCa) incidence, mortality, and diagnostics. Next, the need for novel biomarkers for PCa diagnostics is briefly discussed. The core of the review provides details about PCa aetiology, alternative biomarkers available for PCa diagnostics besides prostate specific antigen and their biosensing. In particular, low molecular mass biomolecules (ions and metabolites) and high molecular mass biomolecules (proteins, RNA, DNA, glycoproteins, enzymes) are discussed, along with clinical performance parameters.
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12
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Lopez-Bujanda ZA, Haffner MC, Chaimowitz MG, Chowdhury N, Venturini NJ, Patel RA, Obradovic A, Hansen CS, Jacków J, Maynard JP, Sfanos KS, Abate-Shen C, Bieberich CJ, Hurley PJ, Selby MJ, Korman AJ, Christiano AM, De Marzo AM, Drake CG. Castration-mediated IL-8 promotes myeloid infiltration and prostate cancer progression. NATURE CANCER 2021; 2:803-818. [PMID: 35122025 PMCID: PMC9169571 DOI: 10.1038/s43018-021-00227-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/26/2021] [Indexed: 11/09/2022]
Abstract
Unlike several other tumor types, prostate cancer rarely responds to immune checkpoint blockade (ICB). To define tumor cell intrinsic factors that contribute to prostate cancer progression and resistance to ICB, we analyzed prostate cancer epithelial cells from castration-sensitive and -resistant samples using implanted tumors, cell lines, transgenic models and human tissue. We found that castration resulted in increased expression of interleukin-8 (IL-8) and its probable murine homolog Cxcl15 in prostate epithelial cells. We showed that these chemokines drove subsequent intratumoral infiltration of tumor-promoting polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs), which was largely abrogated when IL-8 signaling was blocked genetically or pharmacologically. Targeting IL-8 signaling in combination with ICB delayed the onset of castration resistance and increased the density of polyfunctional CD8 T cells in tumors. Our findings establish a novel mechanism by which castration mediates IL-8 secretion and subsequent PMN-MDSC infiltration, and highlight blockade of the IL-8/CXCR2 axis as a potential therapeutic intervention.
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Affiliation(s)
- Zoila A Lopez-Bujanda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA
- Molecular Pathogenesis Program, Kimmel Center for Biology and Medicine, Skirball Institute, New York University School of Medicine, New York, NY, USA
| | - Michael C Haffner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew G Chaimowitz
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nivedita Chowdhury
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nicholas J Venturini
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA
| | - Radhika A Patel
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Aleksandar Obradovic
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA
| | - Corey S Hansen
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Joanna Jacków
- Department of Dermatology, Columbia University, New York, NY, USA
- St John's Institute of Dermatology, King's College London, London, England
| | - Janielle P Maynard
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen S Sfanos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cory Abate-Shen
- Department of Molecular Pharmacology and Therapeutics, Columbia University Irving Medical Center, New York, NY, USA
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Charles J Bieberich
- Department of Biological Sciences, University of Maryland, Baltimore County, Baltimore, MD, USA
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| | - Paula J Hurley
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA
| | - Mark J Selby
- Bristol-Myers Squibb, Redwood City, CA, USA
- Walking Fish Therapeutics, San Francisco, CA, USA
| | - Alan J Korman
- Bristol-Myers Squibb, Redwood City, CA, USA
- Vir Biotechnology, San Francisco, CA, USA
| | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, NY, USA
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - Angelo M De Marzo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles G Drake
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
- Division of Hematology/Oncology, Department of Medicine, Columbia University, New York, NY, USA.
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13
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Rundle AG, Sadasivan SM, Chitale DA, Gupta NS, Williamson SR, Kryvenko ON, Chen Y, Bobbitt K, Tang D, Rybicki BA. Racial differences in the systemic inflammatory response to prostate cancer. PLoS One 2021; 16:e0252951. [PMID: 34242232 PMCID: PMC8270440 DOI: 10.1371/journal.pone.0252951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Systemic inflammation may increase risk for prostate cancer progression, but the role it plays in prostate cancer susceptibility is unknown. From a cohort of over 10,000 men who had either a prostate biopsy or transurethral resection that yielded a benign finding, we analyzed 517 incident prostate cancer cases identified during follow-up and 373 controls with one or more white blood cell tests during a follow-up period between one and 18 years. Multilevel, multivariable longitudinal models were fit to two measures of systemic inflammation, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), to determine NLR and MLR trajectories associated with increased risk for prostate cancer. For both measures, we found no significant differences in the trajectories by case/control status, however in modeling NLR trajectories there was a significant interaction between race (white or Black and case-control status. In race specific models, NLR and MLR values were consistently higher over time among white controls than white cases while case-control differences in NLR and MLR trajectories were not apparent among Black men. When cases were classified as aggressive as compared to non-aggressive, the case-control differences in NLR and MLR values over time among white men were most apparent for non-aggressive cases. For NLR among white men, significant case-control differences were observed for the entire duration of observation for men who had inflammation in their initial prostate specimen. It is possible that, among white men, monitoring of NLR and MLR trajectories after an initial negative biopsy may be useful in monitoring prostate cancer risk.
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Affiliation(s)
- Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Sudha M. Sadasivan
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States of America
| | - Dhananjay A. Chitale
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Nilesh S. Gupta
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Sean R. Williamson
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, United States of America
| | - Oleksandr N. Kryvenko
- Department of Pathology and Laboratory Medicine, Department of Urology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States of America
| | - Kevin Bobbitt
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States of America
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States of America
| | - Benjamin A. Rybicki
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States of America
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14
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Masuda H, Mikami K, Otsuka K, Hou K, Suyama T, Araki K, Kojima S, Naya Y. 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. In Vivo 2021; 35:1641-1646. [PMID: 33910847 DOI: 10.21873/invivo.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Hiroshi Masuda
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kosuke Mikami
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kotaro Otsuka
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kyokusin Hou
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Takahito Suyama
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kazuhiro Araki
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Satoko Kojima
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yukio Naya
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
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15
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Merder E, Arıman A, Dinçer S, Altunrende F. Can we use neutrophil to lymphocyte ratio in the diagnosis and prediction of extracapsular extension in localized prostate cancer? Urologia 2021; 89:203-209. [PMID: 33960239 DOI: 10.1177/03915603211014864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of extracapsular extension (ECE) in clinically localized prostate cancer (PCa). MATERIALS AND METHODS A total of 396 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP), and 260 patients with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy were included in the study. Preoperative NLR, prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, prostate volume (PV), free/total PSA (f/t PSA) in both groups, and relation of NLR with PSA, Gleason Score (GS), and pathologic stage in PCa group were investigated. Records of patients were analyzed retrospectively. RESULTS NLR, free PSA, f/t PSA, and PV were statistically higher in BHP, and PSAD was higher in PCa group. In PCa group, NLR was found to be higher in patients with PSA >10 ng/ml compared to those with less than ⩽10 ng/ml. NLR increases as the preoperative GS increases, and it was higher in pT3 patients than pT2 patients. NLR was statistically higher in those patients with positive lymph nodes than those without after RRP (p = 0.029). CONCLUSION NLR is not a sufficient biomarker in differentiating clinically localized PCa from BPH. NLR increases as preoperative GS and pathologic stage increases. Lymph node involved patients after RRP have statistically higher NLR. NLR can be an indicator of ECE and lymph-node involvement in clinically localized PCa.
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Affiliation(s)
- Erkan Merder
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Arıman
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Prof.Dr.Cemil Taşçıoğlu City Hospital Radiation Oncology, University of Health Sciences, Istanbul
| | - Fatih Altunrende
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
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16
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A novel nomogram predicting the risk of positive biopsy for patients in the diagnostic gray area of prostate cancer. Sci Rep 2020; 10:17675. [PMID: 33077762 PMCID: PMC7572499 DOI: 10.1038/s41598-020-74703-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
The roles played by several inflammatory factors in screening for prostate cancer (PCa) among gray area patients, namely those with serum prostate-specific antigen (PSA) levels between 4 and 10 ng/ml, have not been completely identified, and few effective diagnostic nomograms have been developed exclusively for these patients. We aimed to investigate new independent predictors of positive biopsy (PB) results and develop a novel diagnostic nomogram for this group of patients. The independent predictors of PB results were identified, and a nomogram was constructed using multivariate logistic regression analysis based on a cohort comprising 401 Gy area patients diagnosed at Xijing Hospital (Xi’an, China) between January 2016 and December 2019. The predictive accuracy of the nomogram was assessed using the receiver operating characteristic curve, and the nomogram was calibrated by comparing the prediction with the observation. The performance of the nomogram was further validated using an independent cohort. Finally, lymphocyte-to-monocyte ratio (LMR) > 4.11 and red blood cell distribution width (RDW)-standard deviation (SD) > 42.9 fl were identified as independent protective predictors of PB results, whereas PSA density (PSAD) > 0.141 was identified as an independent risk predictor. The nomogram established using PSAD, LMR, and RDW-SD was perfectly calibrated, and its predictive accuracy was superior to that of PSAD in both internal and external validations (0.827 vs 0.769 and 0.765 vs 0.713, respectively). This study is the first to report the importance of LMR and RDW-SD in screening for PCa among gray area patients and to construct an exclusive nomogram to predict the individual risk of positive 13-core biopsy results in this group of patients. With superior performance over PSAD, our nomogram will help increase the accuracy of PCa screening, thereby avoiding unnecessary biopsy.
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17
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Kawahara T, Kato M, Tabata K, Kojima I, Yamada H, Kamihira O, Tsumura H, Iwamura M, Uemura H, Miyoshi Y. A high neutrophil-to-lymphocyte ratio is a poor prognostic factor for castration-resistant prostate cancer patients who undergo abiraterone acetate or enzalutamide treatment. BMC Cancer 2020; 20:919. [PMID: 32977754 PMCID: PMC7519532 DOI: 10.1186/s12885-020-07410-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Inflammatory cytokine markers, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-lymphocyte ratio, and platelet-to-lymphocyte ratio, play important roles as prognostic markers in several solid malignancies, including prostate cancer. We previously reported the NLR as a poor prognostic marker in bladder cancer, upper-urothelial carcinoma, adrenocortical carcinoma, penile cancer, and prostate cancer. This study examined the importance of the NLR as a prognostic marker for castration-resistant prostate cancer (CRPC) patients who received abiraterone acetate or enzalutamide. METHODS A total of 805 prostate cancer patients developed in CRPC status were enrolled in this study. Of these patients, 449 received abiraterone acetate (ABI; 188 cases) or enzalutamide (ENZ; 261 cases) treatment, and the pre-treatment NLR values of these patients were obtained. We investigated the prognosis in those with higher and lower NLR values. RESULTS The median NLR was 2.90, and a receiver operating characteristics analysis suggested a candidate cut-off point of 3.02. The median overall survival (OS) was 17.3 months in the higher NLR group (≥3.02) and 27.3 months in the lower NLR group (< 3.02) (p < 0.0001). This trend was also observed in both the ABI and ENZ groups (ABI: 29.3 vs. 15.1 months; ENZ: NR vs. 19.5 months; p < 0.0001 and < 0.0001, respectively). A multivariate analysis revealed that a higher NLR was an independent risk factor. The NLR value was thus shown to be correlated with the prostate cancer progression. CONCLUSIONS A higher NLR was associated with a poorer OS for CRPC patients who received ABI or ENZ. The NLR was positively correlated with prostate cancer progression.
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Affiliation(s)
- Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, 2320024 Japan
| | - Masashi Kato
- Department of Urology, Nagoya University, Nagoya, 4668560 Japan
| | - Kenichi Tabata
- Department of Urology, Kitasato University School of Medicine, Sagamihara, 2520375 Japan
| | - Ippei Kojima
- Department of Urology, Nagoya University, Nagoya, 4668560 Japan
| | - Hiroshi Yamada
- Department of Urology, Nagoya University, Nagoya, 4668560 Japan
| | - Osamu Kamihira
- Department of Urology, Nagoya University, Nagoya, 4668560 Japan
| | - Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, 2520375 Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, 2520375 Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, 2320024 Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, 2320024 Japan
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18
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Sonmez G, Tombul ST, Demirtas T, Demirtas A. Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI-RADS 3 lesions. Asia Pac J Clin Oncol 2020; 17:e94-e99. [PMID: 32779392 DOI: 10.1111/ajco.13347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA) < 10 ng/mL. METHODS In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. RESULTS Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. CONCLUSION In patients with PI-RADS 3 lesion and PSA < 10 ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.
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Affiliation(s)
- Gokhan Sonmez
- Department of Urology, Erciyes University, Kayseri, Turkey
| | | | - Turev Demirtas
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
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19
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Murray NP, Fuentealba C, Salazar A, Reyes E. Platelet-to-lymphocyte ratio and systemic immune-inflammation index versus circulating prostate cells to predict significant prostate cancer at first biopsy. Turk J Urol 2020; 46:115-122. [PMID: 32053099 DOI: 10.5152/tud.2020.19203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/12/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE It has been reported that the systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) are higher in men with prostate cancer. We compare their use with the percentage of free prostate-specific antigen (PSA), PSA density, and primary circulating prostate cells (CPCs) to predict clinically significant prostate cancer at first biopsy in men with a PSA of 4-10 ng/mL. MATERIAL AND METHODS Consecutive men with suspicion of prostate cancer underwent a 12-core transrectal ultrasound-guided prostate biopsy; total serum PSA, the percentage of free PSA, prostate ultrasound to calculate PSA density, and absolute neutrophil, lymphocyte, and platelet counts were used for risk assessment. CPCs were detected using differential gel centrifugation and immunocytochemistry with anti-PSA and anti-P504S. A malignant CPC was defined as a cell-expressing PSA and P504S and defined as positive or negative. Biopsies were classified as indicating cancer or no cancer. Areas under the curve for each parameter were calculated and compared, and diagnostic yields were calculated. RESULTS A total of 1223 men participated, and 467 (38%) had a biopsy positive for cancer, whereas 353/467 (76%) had clinically significant prostate cancer. The PLR was significantly higher in men with prostate cancer; there was no significant difference for the SII. The areas under the curves were CPC 0.84, the percentage of free PSA was 0.79, PLR 0.65, PSA density 0.62, and SII 0.46. Neither the PLR nor the SII discriminated between patients with clinically significant prostate cancer, indolent cancer, and benign prostatic disease. CONCLUSION Based on the results of this study, neither the SII nor PLR could differentiate between clinically significant prostate cancer and indolent cancer/benign disease at initial biopsy.
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Affiliation(s)
- Nigel P Murray
- Servicio de Medicina, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile.,Faculty of Medicine, University Finis Terrae, Av Pedro de Valdivia, Providencia, Santiago, Chile
| | - Cynthia Fuentealba
- Servicio de Urologia, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile
| | - Aníbal Salazar
- Servicio de Urologia, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, Chile
| | - Eduardo Reyes
- Servicio de Urologia, Hospital DIPRECA, Vital Apoquindo 1200, Las Condes, Santiago, Chile
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20
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Sun J, Zhang Z, OuYang J. A novel nomogram combined PIRADS v2 and neutrophil-to-lymphocyte ratio to predict the risk of clinically significant prostate cancer in men with PSA < 10 ng/ml at first biopsy. Urol Oncol 2019; 38:401-409. [PMID: 31870724 DOI: 10.1016/j.urolonc.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether Prostate Imaging-Reporting and Data System version 2 (PIRADS v2) and neutrophil-to-lymphocyte ratio(NLR) improve the detection of clinically significant prostate cancer(csCaP) in men with prostate-specific antigen (PSA) <10 ng/ml at first biopsy. METHODS Univariable and multivariable binary logistic regression analysis were used to screen for independent risk factors of csCaP. The multivariable model based on the risk factors was to build the nomogram predicting csCaP and assessed by receiver operator characteristic curve analysis, calibration plot, and decision curve analysis. RESULTS This retrospective study included 335 men with PSA < 10 ng/ml who underwent initial biopsy. A total of 78 (23.3%) men had csCaP. The nomogram was built based on the multivariable model including age, digital rectal examination, free prostate-specific antigen, PIRADS v2, and NLR. It had high area under the curve of 0.876 and was well calibrated in internal validation. Decision curve analysis also demonstrated that it would improve the prediction of csCaP. CONCLUSION PIRADS v2 and NLR improve the detection of csCaP in men with PSA < 10 ng/ml at first biopsy. Due to lack of external validation, relatively small cohort and homogenous population, the study has several limitations. Despite of this, the nomogram based on our study is a promising tool for patients to understand their risk of csCaP and for urologists to make clinical decisions.
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Affiliation(s)
- JiaLe Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - ZhiYu Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jun OuYang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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21
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Baran O, Kemerdere R, Korkmaz TS, Kayhan A, Tanriverdi T. Can preoperative neutrophil to lymphocyte, lymphocyte to monocyte, or platelet to lymphocyte ratios differentiate glioblastoma from brain metastasis? Medicine (Baltimore) 2019; 98:e18306. [PMID: 31852112 PMCID: PMC6922586 DOI: 10.1097/md.0000000000018306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/29/2019] [Accepted: 11/06/2019] [Indexed: 12/20/2022] Open
Abstract
This retrospective analysis of patients aims to show the blood levels of preoperative inflammatory markers in patients with glioblastoma and brain metastasis and to provide the diagnostic accuracy of the neutrophil-lymphocyte (NLR), lymphocyte-monocyte (LMR), and platelet-lymphocyte (PLR) ratios between the 2 groups of patients.The retrospective reviews of the neutrophil, lymphocyte, monocyte, and platelet counts were analyzed in 80 patients with newly diagnosed glioblastoma and 70 patients with brain metastasis. The NLR, LMR, and PLR were calculated in each group. The differences in all the parameters were compared between the 2 groups.Although the neutrophil, monocyte, and platelet counts were higher and the lymphocyte count was lower in patients with metastasis, the difference was not significant. A significantly higher PLR (P = .004) and a lower LMR (P = .01) were found in patients with brain metastasis. Although both PLR and LMR had diagnostic accuracy in differentiating glioblastoma from brain metastasis, LMR showed the highest diagnostic accuracy. NLR showed no diagnostic accuracy.Systemic inflammation is more severe in glioblastoma than in brain metastasis, and LMR is more sensitive and/or specific than PLR in differentiating glioblastoma from brain metastasis. Therefore, LMR (less likely PLR) can be used as an index for differentiating between glioblastoma and brain metastasis before surgery.
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Affiliation(s)
- Oguz Baran
- Department of Neurosurgery, Haseki Research and Training Hospital
| | - Rahsan Kemerdere
- Department of Neurosurgery, Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Taha Sukru Korkmaz
- Department of Neurosurgery, Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Ahmet Kayhan
- Department of Neurosurgery, Haseki Research and Training Hospital
| | - Taner Tanriverdi
- Department of Neurosurgery, Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
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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.
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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
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The Pretherapeutic Neutrophil-to-Lymphocyte Ratio for Docetaxel-Based Chemotherapy Is Useful for Predicting the Prognosis of Japanese Patients with Castration-Resistant Prostate Cancer. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2535270. [PMID: 31781602 PMCID: PMC6875305 DOI: 10.1155/2019/2535270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 10/12/2019] [Indexed: 01/04/2023]
Abstract
Introduction and Objectives The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a simple marker of the systemic inflammatory response in critical care patients. The NLR can be easily calculated from routine complete blood counts in the peripheral blood. This parameter has been reported to be an independent prognosticator for some solid malignancies. In the present study, we examined the importance of the NLR as a prognostic marker for castration-resistant prostate cancer (CRPC) patients who received docetaxel- (DOC-) based chemotherapy. Methods We analyzed a total of 73 patients who received DOC chemotherapy for CRPC in Yokohama City University Medical Center and affiliated hospitals. 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 before the initiation of DOC chemotherapy. We determined the NLR cutoff value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. Results The median overall survival (OS) after DOC was 21.0 months (range: 2.0–51.0). The median OS was shorter in patients with a high NLR (≥2.59) than in those with a low NLR (<2.59) (12.0 versus 31.6 months, p=0.001). In the multivariate analysis, the NLR and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.643, p=0.001; hazard ratio 2.184, p=0.038, respectively). Conclusions The higher NLR group showed a significantly poorer OS than the lower NLR group. Pre-DOC NLR might be a new marker for predicting the prognosis of patients who receive DOC chemotherapy.
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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.
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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
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Kemerdere R, Akgun MY, Toklu S, Alizada O, Tanriverdi T. Preoperative systemic inflammatory markers in low- and high-grade gliomas: A retrospective analysis of 171 patients. Heliyon 2019; 5:e01681. [PMID: 31193037 PMCID: PMC6513782 DOI: 10.1016/j.heliyon.2019.e01681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/28/2019] [Accepted: 05/03/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) are recognized as prognostic markers of grade of gliomas. The aim of this study was to determine whether preoperative levels of NLR, PLR, and LMR differ between low- and high-grade gliomas. Methods Retrospective analysis of preoperative neutrophil, lymphocyte, monocyte, and platelet counts and NLR, PLR, and LMR were performed in 171 patients who underwent glioma surgery. The results were compared between low- and high-grade gliomas. Results Neutrophil count was significantly increased while lymphocyte count significantly decreased in high-grade gliomas (HGGs). NLR and PLR were significantly higher in HGGs but LMR was significantly reduced in HGGs. NLR and PLR correlated with glioma grade and only NLR showed highest accuracy predicting higher grade. Conclusions Levels of preoperative NLR value can help to evaluate disease progression and predict higher grade of glioma.
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Affiliation(s)
- Rahsan Kemerdere
- Department of Neurosurgery, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sureyya Toklu
- Department of Neurosurgery, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Orkhan Alizada
- Department of Neurosurgery, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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26
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Adhyatma KP, Warli SM. Diagnostic Value of Platelet-To-Lymphocyte Ratio in Prostate Cancer. Open Access Maced J Med Sci 2019; 7:1093-1096. [PMID: 31049087 PMCID: PMC6490494 DOI: 10.3889/oamjms.2019.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Previous studies demonstrated the promising value of platelet-to-lymphocyte (PLR) in prostate cancer. AIM This study was conducted to evaluate its pre-biopsy values in predicting prostate cancer. METHODS We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent a prostate biopsy in Adam Malik Hospital between August 11th 2011 and August 31st 2015. The relationship between pre-biopsy variables which could be affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and prostate volume (EPV). The PLR was calculated from the ratio of related platelets with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa. RESULTS As many as 298 patients consisted of 126 (42.3%) BPH and 172 PCa (57.7%) patients are included in this study. 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 PSA (19.28 ± 27.11 vs 40.19 ± 49.39), EPV (49.39 ± 23.51 vs 58.10 ± 30.54), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both groups (p < 0.05). The 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). Besides, the NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. We asked for permission from the preceding authors of Indonesian Prostate Cancer Risk Calculator (IPCRC) and calculated its value from 98 randomised patients consist of 45 (45.92%) BPH and 53 (54.08%) PCa. We found a comparable value between PLR/NLR with IPCRC in predicting prostate cancer (AUC of 67.6%, 75.3%, and 68.4%, respectively) with a statistically significant difference of all value in both groups (p < 0.05). CONCLUSIONS PLR gives promising value in predicting prostate cancer in suspected patients. We suggest a further prospective study to validate its diagnostic values so it can be used as applicable routine calculation.
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Affiliation(s)
- Kharisma Prasetya Adhyatma
- Department of Urology, Faculty of Medicine, Sumatera Utara University, Adam Malik Hospital, Medan, Indonesia
| | - Syah Mirsya Warli
- Department of Urology, Faculty of Medicine, Sumatera Utara University, Adam Malik Hospital, Medan, Indonesia
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27
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Lu Y, Huang HH, Lau WKO. Evaluation of neutrophil-to-lymphocyte ratio as a prognostic indicator in a Singapore cohort of patients with clinically localized prostate cancer treated with prostatectomy. World J Urol 2019; 38:103-109. [PMID: 30953141 DOI: 10.1007/s00345-019-02752-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/31/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Recent evidence suggests that the presence of a systemic inflammatory response plays an important role in the progression of several solid tumors. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as easily assessable markers of systemic inflammation and has been shown to represent a prognostic marker in prostate cancer in previous studies. METHODS Data from 668 patients with localized prostate cancer treated with prostatectomy (open and robot assisted) in Singapore General Hospital from 1998 to 2014 were analyzed. Correlation between NLR and histopathological status was analyzed. Association between NLR and distant metastases-free survival (MFS), cancer-specific survival (CSS), overall survival (OS), and biochemical disease-free survival (BDFS) was assessed. RESULTS NLR was not significantly correlated with histopathological status, including Gleason score (≤ 6 versus 7 versus ≥ 8, p = 0.159), lymph node metastasis (negative versus positive, p = 0.159), or surgical margin status (negative versus positive, p = 0.494). NLR was categorized into two groups (< median and ≥ median, median = 2.09) and NLR ≥ 2.09 was not a prognostic factor for decreased MFS (p = 0.609), CSS (p = 0.302), OS (p = 0.722) and BDFS (p = 0.589). No difference was observed for NLR even in high-risk subgroup patients compared to the rest (p = 0.058). The area under the ROC curve (AUC) of NLR as a prognosticator for biochemical recurrence was only 0.53. CONCLUSION Our findings indicate that pre-treatment NLR may not predict prognosis in patients with localized prostate cancer treated with prostatectomy in an Asian cohort.
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Affiliation(s)
- Yadong Lu
- Department of Urology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Weber Kam On Lau
- Department of Urology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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28
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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.
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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
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Hayashi T, Fujita K, Tanigawa G, Kawashima A, Nagahara A, Ujike T, Uemura M, Takao T, Yamaguchi S, Nonomura N. Serum monocyte fraction of white blood cells is increased in patients with high Gleason score prostate cancer. Oncotarget 2018; 8:35255-35261. [PMID: 27823973 PMCID: PMC5471051 DOI: 10.18632/oncotarget.13052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/28/2016] [Indexed: 01/21/2023] Open
Abstract
Systemic inflammation and immune responses are reported to be associated with progressive prostate cancer. In this study, we explored which among the fractions of white blood cell (WBC) and C-reactive protein (CRP) level were associated with high Gleason score prostate cancer. Prostate needle biopsy was performed in 966 men with suspicion of prostate cancer. We assessed age, serum prostate-specific antigen (PSA), prostate volume, WBC count, fractions of WBCs (neutrophils, lymphocytes, monocytes, basophils, and eosinophils), and CRP level before biopsy for associations with biopsy findings. Among all men, 553 (57.2%) were positive for prostate cancer including 421 with high Gleason score cancer (Gleason score ≥7). Age, PSA, PSA density (PSAD), serum monocyte fraction of WBC, monocyte-to-lymphocyte ratio (MLR), and CRP were significantly associated with high Gleason score cancer (p<0.01). Multivariate analysis showed that age, PSA, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p <0.01). In 571 patients with PSA of <10 ng/ml, age, PSA, PSAD, serum WBC count, neutrophil fraction, monocyte fraction, and MLR were significantly associated with high Gleason score prostate cancer (p<0.05). Multivariate analysis showed that age, PSAD, and serum monocyte fraction were significantly associated with high Gleason score prostate cancer (p<0.01). The monocyte fraction of WBCs was increased in patients with high Gleason score prostate cancer, suggesting an interaction of monocytes with the progression of prostate cancer.
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Affiliation(s)
- Takuji Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Go Tanigawa
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nagahara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Seiji Yamaguchi
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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30
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Huang Y, Li ZZ, Huang YL, Song HJ, Wang YJ. Value of free/total prostate-specific antigen (f/t PSA) ratios for prostate cancer detection in patients with total serum prostate-specific antigen between 4 and 10 ng/mL: A meta-analysis. Medicine (Baltimore) 2018; 97:e0249. [PMID: 29595681 PMCID: PMC5895418 DOI: 10.1097/md.0000000000010249] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prostate carcinoma is a common disease that occurs in men over 50 years old. Many studies have explored the effect of free/total prostate-specific antigen (f/t PSA) ratio in monitoring prostate cancer. We conducted a meta-analysis to identify the accuracy of the f/t PSA ratio in the diagnosis of prostate cancer in patients who have PSA levels of 4 to 10 ng/mL. METHODS Databases searched included PubMed and OVID databases, from inception to March 2017, after a systematical review, sensitivity, specificity, and other measures of accuracy of the f/t PSA ratio in the diagnosis of prostate cancer were pooled. We used summary receiver operating characteristic curves to summarize overall test performance. RESULTS Fifteen case-control studies from 14 articles were identified. The results indicated that the sensitivity of the f/t PSA ratio in the diagnosis of prostate cancer ranged from 0.5 to 0.94 (pooled sensitivity 0.70, 95% CI: 0.67-0.72), whereas its specificity ranged from 0.31 to 0.93 (pooled specificity 0.55, 95% CI: 0.57-0.60). The positive likelihood ratio was 1.85 (95% CI: 1.56-2.20), negative likelihood ratio was 0.42 (95% CI: 0.34-0.53), and diagnostic odds ratio was 4.81 (9.53% CI: 3.33-6.94). CONCLUSIONS The f/t PSA ratio determination has a low sensitivity and specificity for the diagnosis of prostate cancer; it would not be useful for the diagnosis of prostate cancer by itself. The results of f/t PSA ratio measurements should refer to the clinical manifestations and the results of conventional tests such as biopsies.
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Affiliation(s)
- Yan Huang
- Health Management Center, West China Hospital of Sichuan University
| | - Zhen-Zhen Li
- Health Management Center, West China Hospital of Sichuan University
| | - Ya-Liang Huang
- Department of Nephrology and Rheumatology, Affiliated Hospital/Clinical Medical College of Chengdu University
| | - Hong-Jun Song
- Out-patient Department, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - You-Juan Wang
- Health Management Center, West China Hospital of Sichuan University
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Murata H, Koyama K, Takezawa Y, Nishigaki Y. Baseline neutrophil-to-lymphocyte ratio predicts the prognosis of castration-resistant prostate cancer treated with abiraterone acetate. Mol Clin Oncol 2018; 8:592-594. [PMID: 29541468 DOI: 10.3892/mco.2018.1562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/28/2017] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Hiroaki Murata
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Kenzou Koyama
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Yasunobu Takezawa
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Yasunori Nishigaki
- Department Orthopaedics, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
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Xu W, Wang D, Zheng X, Ou Q, Huang L. Sex-dependent association of preoperative hematologic markers with glioma grade and progression. J Neurooncol 2017; 137:279-287. [DOI: 10.1007/s11060-017-2714-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
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Elevated preoperative neutrophil-lymphocyte ratio predicts upgrading at radical prostatectomy. Prostate Cancer Prostatic Dis 2017; 21:100-105. [PMID: 29230007 DOI: 10.1038/s41391-017-0015-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 09/06/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is a widely used, representative marker of systemic inflammatory response within the body. NLR can be calculated from simple, inexpensive peripheral blood samples. High NLR is a negative prognostic factor in a variety of malignancies including urological tumors. In this study, we aim to assess the prognostic value of preoperative neutrophil- lymphocyte ratio (NLR) in patients treated with radical prostatectomy (RP) for localized prostate cancer (PCa). MATERIALS AND METHODS Records of 7426 patients were retrospectively analyzed from prospectively collected datasets. A cut-off point of 3 was taken for NLR based on ROC analyses and previous literature. RESULTS 23% (n = 1707) of patients had an NLR of ≥3. Patients with NLR ≥3 were more likely to harbor unfavorable pathological features such as higher biopsy Gleason score (GS), higher RP GS, higher rates of extra capsular extension, nodal involvement (all p < 0.001) and positive surgical margins (p = 0.002). On multivariable analyses, NLR ≥ 3 was associated with higher RP GS (OR 2.32; p < 0.001), seminal vesicle invasion (OR 1.60; p < 0.001) and nodal involvement (OR 1.43; p < 0.001). On multivariable analyses, NLR ≥ 3 was significantly associated with GS upgrading at RP (OR 1.39 p < 0.001). During a median follow up of 45 months, NLR ≥ 3 was associated with higher risk of BCR (p = 0.001). However, on multivariable Cox regression analysis such association was not shown (HR 0.86; p = 0.4). CONCLUSION Preoperative NLR ≥ 3 was associated with aggressive PCa, such as upgrading at RP. Even though its effect on clinical-decision making seems to be limited when all clinical and pathological confounders are taken into account, preoperative NLR may still be useful in selected patients to identify aggressive PCa helping patient selection for active surveillance protocols. Conversely, it does not predict BCR when adjusted for the effect of pathological features.
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Wang H, Gu L, Wu Y, Feng D, Duan J, Wang X, Huang Y, Wu S, Chen J, Luo G, Zhang X. The values of neutrophil-lymphocyte ratio and/or prostate-specific antigen in discriminating real Gleason score ≥ 7 prostate cancer from group of biopsy-based Gleason score ≤ 6. BMC Cancer 2017; 17:629. [PMID: 28874127 PMCID: PMC5586011 DOI: 10.1186/s12885-017-3614-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/28/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The discrepant concordance between biopsy and radical prostatectomy (RP) specimen are well reported. To validate the clinical usefulness of neutrophil-lymphocyte ratio (NLR) in discriminating real GS ≥ 7 PCa from biopsy-based GS ≤ 6 PCa in comparison with serum total prostate-specific antigen (tPSA) and value of their combination. METHODS One hundred one patients who underwent physical examinations incidentally found elevated tPSA and subsequently received biopsy with a conclusion of GS ≤ 6 and RP with an interval of 4-6 weeks after biopsy were enrolled. NLR and tPSA were obtained within 15 days prior to biopsy. Logistic regression model was applied appropriately; McNemar tests and AUC model were performed to evaluate differences among tPSA, NLR and their combination and corresponding diagnostic power respectively. RESULTS The pathological results from RP specimen comprised 61 patients with GS ≤ 6 and 100 patients with GS ≥ 7. Higher tPSA and NLR were significantly associated with patients with actual GS ≥ 7 (All P < 0.05) concurrently. Multivariate logistic regression indicated that tPSA (OR = 1.088, 95% C.I. = 1.029-1.151, P = 0.003) and NLR (OR = 1.807, 95% C.I. = 1.021-3.200, P = 0.042) could be independent predictors for GS groupings. Under cutoff value of 14.09 ng/ml for tPSA and 2.25 for NLR, the sensitivity, specificity and accuracy were 60.0%, 80.3% and 67.7% for tPSA, 42%, 88.5% and 59.6% for NLR, and 71.0%, 75.4% and 72.7% for combination of tPSA and NLR (tPSA + NLR) respectively. The sensitivity of tPSA + NLR was significantly higher in comparison with tPSA (P = 0.001) and NLR (P < 0.001). Except for sensitivity, no significant difference was found between tPSA and NLR in specificity (P = 0.227) and accuracy (P = 0.132). tPSA got the largest AUC with 0.732 (p < 0.001, 95% C.I.: 0.651-0.813). CONCLUSIONS Serum tPSA and NLR were significantly elevated among GS ≥ 7 PCa concurrently. The combination of tPSA and NLR might have additional benefit to biopsy on discriminating real GS ≥ 7 Pca from biopsy-based GS ≤ 6 PCa. More stratification models and prospectively multicenter studies are necessary.
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Affiliation(s)
- Hanfeng Wang
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Liangyou Gu
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Yongjie Wu
- Department of General Surgery, Chinese PLA 264 Hospital, Taiyuan, 030000, China
| | - Dan Feng
- Hospital Management Institute, Medical Statistic Division, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, China
| | - Junyao Duan
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Xiaocong Wang
- Department of Pathology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, China
| | - Yong Huang
- Department of Pathology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, China
| | - Shengpan Wu
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Jianwen Chen
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Guangda Luo
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital/PLA Medical School, Beijing, 100853, People's Republic of China.
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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.
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Lopez-Bujanda Z, Drake CG. Myeloid-derived cells in prostate cancer progression: phenotype and prospective therapies. J Leukoc Biol 2017; 102:393-406. [PMID: 28550116 PMCID: PMC6608078 DOI: 10.1189/jlb.5vmr1116-491rr] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/21/2022] Open
Abstract
Prostate cancer is the second most common cause of cancer mortality in men in the United States. As is the case for other tumor types, accumulating evidence suggests an important role for myeloid-derived cells in the promotion and progression of prostate cancer. Here, we briefly describe myeloid-derived cells that interact with tumor cells and what is known about their immune suppressive function. We next discuss new evidence for tumor cell-mediated myeloid infiltration via the PI3K/PTEN/AKT signaling pathway and an alternative mechanism for immune evasion that may be regulated by an endoplasmic reticulum stress response. Finally, we discuss several interventions that target myeloid-derived cells to treat prostate cancer.
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Affiliation(s)
- Zoila Lopez-Bujanda
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Charles G Drake
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
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Mochizuki T, Kawahara T, Takamoto D, Makiyama K, Hattori Y, Teranishi JI, Miyoshi Y, Yumura Y, Yao M, Uemura H. The neutrophil-to-lymphocyte ratio (NLR) predicts adrenocortical carcinoma and is correlated with the prognosis. BMC Urol 2017; 17:49. [PMID: 28662713 PMCID: PMC5490233 DOI: 10.1186/s12894-017-0240-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) is reported as a biomarker for some solid malignant diseases. Thus far, however, no reports of the relationship between the NLR and adrenal tumors have been published. We analyzed the utility of the preoperative NLR as a biomarker for predicting the prognosis or diagnosis of malignant disease. Methods A total of 59 patients with adrenal tumors (13 cases of malignant disease and 46 with benign disease) were analyzed in this study from February 2004 to June 2015 at our institute. The NLR was obtained just before adrenalectomy. The diagnosis of adrenal tumor was confirmed by a pathological examination of surgical specimens. Results The NLR in malignant adrenal tumor specimens was significantly higher than in non-malignant specimens (p = 0.028). Adrenocortical carcinoma (ACC) showed the highest NLR among all adrenal tumors. In ACC, the higher NLR group (NLR ≥ 5) showed a significantly poorer overall survival than the lower NLR group (NLR < 5) (p = 0.032). Conclusions In adrenal tumors, a higher NLR indicates a higher incidence of malignancy. The NLR might be a new biomarker for predicting the prognosis of adrenal tumor patients.
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Affiliation(s)
- Taku Mochizuki
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan. .,Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Hattori
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Jun-Ichi Teranishi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Yasushi Yumura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 2320024, Japan
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Sun Z, Ju Y, Han F, Sun X, Wang F. Clinical implications of pretreatment inflammatory biomarkers as independent prognostic indicators in prostate cancer. J Clin Lab Anal 2017; 32. [PMID: 28605139 DOI: 10.1002/jcla.22277] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/16/2017] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Zhaohui Sun
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Ju
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Fuyan Han
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Xiya Sun
- School of Basic Medical Sciences of Lanzhou University, Lanzhou, Gansu, China
| | - Fang Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, Shandong, China
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Prognostic factors of first-line docetaxel treatment in castration-resistant prostate cancer: roles of neutrophil-to-lymphocyte ratio in patients from Northwestern China. Int Urol Nephrol 2017; 49:629-635. [DOI: 10.1007/s11255-017-1524-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
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Huang TB, Mao SY, Lu SM, Yu JJ, Luan Y, Gu X, Liu H, Zhou GC, Ding XF. Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of prostate cancer among men who underwent template-guided prostate biopsy: A STROBE-compliant study. Medicine (Baltimore) 2016; 95:e5307. [PMID: 27858908 PMCID: PMC5591156 DOI: 10.1097/md.0000000000005307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in diagnosis of prostate cancer (PCa). Data of 662 patients who underwent prostate biopsy from January 2012 to June 2016 were retrospectively reviewed. The receiver operating characteristic-derived area under the curve analyses were performed to assess the predictive accuracy. Simultaneously, Youden's index was calculated to determine the optimal NLR cutoff. Furthermore, univariate and multivariate logistic regression analyses were performed to determine the association between NLR value and PCa detection. On account of an NLR value of 2.44 was shown with the maximal Youden's index on the receiver operating characteristic curve, the cutoff value of NLR was set at 2.44. Accordingly, patients were classified into high-NLR or low-NLR group. The patients in high-NLR group might have significant higher risk to be diagnosed with PCa (HR 1.640; P = 0.031), especially in the subgroup with prostate-specific antigen (PSA) ranged from 4 to 10 ng mL (hazard ratio [HR] 4.364; P = 0.003). The high-NLR was independent of age of diagnosis, PSA, prostate volume, abnormal digital rectal examination, and hypoechoic lesion on transrectal ultrasound for positive prostate biopsy. In the so-called gray area, combination of NLR value could raise 4.6% of the accuracy of the multivariate logistic model in PCa prediction, but not in advanced PCa prediction.The patients with high-NLR value may have significant higher risk to be diagnosed with PCa, especially among the patients with PSA ranged from 4 to 10 ng mL. In this subgroup, the adding of NLR value in the multivariate model can improve the accuracy of PCa prediction in a large degree. If validated, the NLR will become a promising, accessible, inexpensive biomarker for PCa prediction.
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Affiliation(s)
- Tian-bao Huang
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
| | - Shi-yu Mao
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Sheng-ming Lu
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
| | - Jun-jie Yu
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
| | - Yang Luan
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
| | - Xiao Gu
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
| | - Hao Liu
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Guang-chen Zhou
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
- Correspondence: Xue-fei Ding, No. 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China (e-mail: ); Guang-chen Zhou, No. 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China (e-mail: )
| | - Xue-fei Ding
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
- Department of Urology, College of Clinical Medicine, Yangzhou, Jiangsu Province, China
- Correspondence: Xue-fei Ding, No. 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China (e-mail: ); Guang-chen Zhou, No. 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China (e-mail: )
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Gokce MI, Hamidi N, Suer E, Tangal S, Huseynov A, Ibiş A. Author reply: The neutrophil-to-lymphocyte ratio in clinical practice. Can Urol Assoc J 2016; 10:142. [PMID: 27217864 DOI: 10.5489/cuaj.3630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Semih Tangal
- Department of Urology, Ufuk University School of Medicine, Ankara, Turkey
| | - Adil Huseynov
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Arif Ibiş
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Lack of an Association between Neutrophil-to-Lymphocyte Ratio and PSA Failure of Prostate Cancer Patients Who Underwent Radical Prostatectomy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6197353. [PMID: 27200375 PMCID: PMC4855032 DOI: 10.1155/2016/6197353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/15/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022]
Abstract
Introduction. The neutrophil-to-lymphocyte ratio (NLR), which can be easily calculated from routine complete blood counts of the peripheral blood, has been suggested to serve as a prognostic factor for some solid malignancies. In the present study, we aimed to determine the relationship between NLR in prostate cancer patients undergoing radical prostatectomy (RP) and their prognosis. Materials and Methods. We assessed NLR in 73 men (patients) who received RP for their prostate cancer. We also performed immunohistochemistry for CD8 and CD66b in a separate set of RP specimens. Results. The median NLR in the 73 patients was 1.85. There were no significant correlations of NLR with tumor grade (p = 0.834), pathological T stage (p = 0.082), lymph node metastasis (p = 0.062), or resection margin status (p = 0.772). Based on the area under the receiver operator characteristic curve (AUROC) to predict biochemical recurrence after RP, potential NLR cut-off point was determined to be 2.88 or 3.88. However, both of these cut-off points did not precisely predict the prognosis. There were no statistically significant differences in the number of CD66b-positive neutrophils or CD8-positive lymphocytes between stromal tissues adjacent to cancer glands and stromal tissues away from cancer glands and between different grades or stages of tumors. Conclusions. There was no association between NLR and biochemical failure after prostatectomy.
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Tang L, Li X, Wang B, Luo G, Gu L, Chen L, Liu K, Gao Y, Zhang X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Localized and Advanced Prostate Cancer: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0153981. [PMID: 27096158 PMCID: PMC4838250 DOI: 10.1371/journal.pone.0153981] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/06/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE AND BACKGROUND Increasing evidence suggests that inflammation plays an essential role in cancer development and progression. The inflammation marker neutrophil-lymphocyte ratio (NLR) is correlated with prognosis across a wide variety of tumor types, but its prognostic value in prostate cancer (PCa) remains controversial. In the present meta-analysis, the prognostic value of NLR in PCa patients is investigated. METHODS We performed a meta-analysis to determine the predictive value of NLR for overall survival (OS), recurrence-free survival (RFS), and clinical features in patients with PCa. We systematically searched PubMed, ISI Web of Science, and Embase for relevant studies published up to October 2015. RESULTS A total of 9418 patients from 18 studies were included in the meta-analysis. Elevated pretreatment NLR predicted poor OS (HR 1.628, 95% CI 1.410-1.879) and RFS (HR 1.357, 95% CI 1.126-1.636) in all patients with PCa. However, NLR was insignificantly associated with OS in the subgroup of patients with localized PCa (HR 1.439, 95% CI 0.753-2.75). Increased NLR was also significantly correlated with lymph node involvement (OR 1.616, 95% CI 1.167-2.239) but not with pathological stage (OR 0.827, 95% CI 0.637-1.074) or Gleason score (OR 0.761, 95% CI 0.555-1.044). CONCLUSIONS The present meta-analysis indicated that NLR could predict the prognosis for patients with locally advanced or castration-resistant PCa. Patients with higher NLR are more likely to have poorer prognosis than those with lower NLR.
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Affiliation(s)
- Lu Tang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Xintao Li
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Baojun Wang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Guoxiong Luo
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Liangyou Gu
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Luyao Chen
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Kan Liu
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Yu Gao
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
| | - Xu Zhang
- State Key Laboratory of Kidney Disease, Department of Urology, Chinese PLA Medical Academy, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China
- * E-mail:
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Maeda Y, Kawahara T, Kumano Y, Ohtaka M, Kondo T, Mochizuki T, Hattori Y, Teranishi JI, Miyoshi Y, Yumura Y, Miyamoto H, Yao M, Uemura H. The Neutrophil-to-Lymphocyte Ratio before Repeat Prostate Needle Biopsy for Predicting Prostate Cancer. Urol Int 2015; 96:123-4. [DOI: 10.1159/000442895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
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