Young Suk Kwon1, Christopher Sejong Han2, Ji Woong Yu3, Sinae Kim1, Parth Modi2, Rachel Davis2, Ji Hae Park2, Paul Lee4, Yun-Sok Ha5, Wun-Jae Kim6, Isaac Yi Kim7. 1. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ. 2. Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. 3. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ. 5. Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea. 6. Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea. 7. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: kimiy@cinj.rutgers.edu.
Abstract
UNLABELLED: Appropriate patient selection for active surveillance is challenging.Our study of 217 patients demonstrated that the preoperative absolute neutrophil and lymphocyte counts were better predictors of aggressive oncologic features than were the neutrophil-to-lymphocyte ratio in the assessment of low-risk prostate cancer patients. Our findings suggest that routine hematologic workup could be used to further stratify low-risk prostate cancer patients. INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) has emerged as a ubiquitous prognostic biomarker in cancer-related inflammation, specifically in patients with metastatic castration-resistant prostate cancer (PCa). We evaluated the clinical utility of the preoperative NLR, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) as a risk stratification tool for patients with low-risk PCa. MATERIALS AND METHODS: We identified 217 low-risk PCa patients with preoperative hematologic data who had met the criteria for active surveillance but had undergone robot-assisted radical prostatectomy at our institution from 2006 to 2015. Logistic regression models were constructed to determine whether the baseline NLR, ANC, and ALC were associated with upstaging, upgrading, and biochemical recurrence (BCR). Survival analyses were performed using the Kaplan-Meier method. RESULTS: On multivariate analysis, a higher prostate-specific antigen level (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.148-2.104), a greater number of positive cores (OR, 2.098; 95% CI, 1.043-2.104), and a higher ALC (OR, 4.311; 95% CI, 1.258-14.770) were associated with upstaging. More importantly, the 5-year biochemical recurrence-free survival was significantly lower in the high ANC group (ANC > 4.0 × 10(9)/L) compared with that of the low ANC group (P = .011). The NLR was not associated with upstaging, upgrading, or BCR in our study cohort (P = .368, P = .573, and P = .504, respectively). The only significant association with upgrading was patient age (OR, 1.106; 95% CI, 1.043-1.173). CONCLUSION: NLR was not useful in predicting adverse pathologic outcomes in our patients with low-risk PCa. However, relative neutrophilia and lymphocytosis might indicate an early manifestation of harboring a more aggressive PCa.
UNLABELLED: Appropriate patient selection for active surveillance is challenging.Our study of 217 patients demonstrated that the preoperative absolute neutrophil and lymphocyte counts were better predictors of aggressive oncologic features than were the neutrophil-to-lymphocyte ratio in the assessment of low-risk prostate cancerpatients. Our findings suggest that routine hematologic workup could be used to further stratify low-risk prostate cancerpatients. INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) has emerged as a ubiquitous prognostic biomarker in cancer-related inflammation, specifically in patients with metastatic castration-resistant prostate cancer (PCa). We evaluated the clinical utility of the preoperative NLR, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) as a risk stratification tool for patients with low-risk PCa. MATERIALS AND METHODS: We identified 217 low-risk PCa patients with preoperative hematologic data who had met the criteria for active surveillance but had undergone robot-assisted radical prostatectomy at our institution from 2006 to 2015. Logistic regression models were constructed to determine whether the baseline NLR, ANC, and ALC were associated with upstaging, upgrading, and biochemical recurrence (BCR). Survival analyses were performed using the Kaplan-Meier method. RESULTS: On multivariate analysis, a higher prostate-specific antigen level (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.148-2.104), a greater number of positive cores (OR, 2.098; 95% CI, 1.043-2.104), and a higher ALC (OR, 4.311; 95% CI, 1.258-14.770) were associated with upstaging. More importantly, the 5-year biochemical recurrence-free survival was significantly lower in the high ANC group (ANC > 4.0 × 10(9)/L) compared with that of the low ANC group (P = .011). The NLR was not associated with upstaging, upgrading, or BCR in our study cohort (P = .368, P = .573, and P = .504, respectively). The only significant association with upgrading was patient age (OR, 1.106; 95% CI, 1.043-1.173). CONCLUSION: NLR was not useful in predicting adverse pathologic outcomes in our patients with low-risk PCa. However, relative neutrophilia and lymphocytosis might indicate an early manifestation of harboring a more aggressive PCa.
Authors: Albert El Hajj; Guillaume Ploussard; Alexandre de la Taille; Yves Allory; Dimitri Vordos; Andras Hoznek; Claude Clément Abbou; Laurent Salomon Journal: BJU Int Date: 2012-06-21 Impact factor: 5.588
Authors: W S Jang; K S Cho; K H Kim; C Y Yoon; Y J Kang; J Y Lee; W S Ham; K H Rha; S J Hong; Y D Choi Journal: Prostate Cancer Prostatic Dis Date: 2016-06-28 Impact factor: 5.554
Authors: Carlo A Bravi; Giuseppe Rosiello; Giuseppe Fallara; Emily Vertosick; Amy Tin; Daniel Sjoberg; Marco Bianchi; Elio Mazzone; Alberto Martini; Paolo Dell'oglio; Armando Stabile; Giorgio Gandaglia; Nicola Fossati; Alberto Briganti; Francesco Montorsi; Andrew Vickers Journal: Minerva Urol Nephrol Date: 2020-02-19