Mehmet Özsoy1,2, Marco Moschini1,3, Harun Fajkovic1,2, Francesco Soria1,4, Christian Seitz1,2, Tobias Klatte1,2, Kilian Gust1, Alberto Briganti3, Pierre I Karakiewicz5, Morgan Roupret6, Gero Kramer1, Shahrokh F Shariat7,8,9,10. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 2. Karl Landsteiner Society, Urology and Andrology, Vienna, Austria. 3. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 4. Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada. 6. Department of Urology, Pitié-Salpétrière Hospital, University Paris, Paris, France. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at. 8. Karl Landsteiner Society, Urology and Andrology, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at. 9. Department of Urology, Weill Cornell Medical College, New York, NY, USA. shahrokh.shariat@meduniwien.ac.at. 10. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. shahrokh.shariat@meduniwien.ac.at.
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.
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.
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