A high neutrophil-to-lymphocyte ratio is a poor prognostic factor for castration-resistant prostate cancer patients who undergo abiraterone acetate or enzalutamide treatment

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.

Prognostic role of pan‐immune‐inflammation value in patients with metastatic castration‐resistant prostate cancer treated with androgen receptor‐signaling inhibitors

“…Systemic immunity and cancer‐related inflammation are effective on prognosis in patients with cancer 13 . The effects of inflammatory markers neutrophil‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR) on prognosis in patients mCRPC treated with abiraterone or enzalutamide were evaluated 3 .…”

“…Similar to our findings regarding the role of systemic immunity in patients with mCRPC, Fan et al 18 concluded that the systemic‐immune‐inflammation index, calculated by using lymphocyte, neutrophil, and platelet, had a prognostic role in those patients treated with AA and docetaxel. Furthermore, Kawahara et al 13 showed that NLR was prognostic in patients with mCRPC treated with AA or enzalutamide. It should be noticed that PIV includes four systemic inflammation indicators and may better represent the systemic inflammation in patients with cancer.…”

A Novel Nomogram Based on Machine Learning-Pathomics Signature and Neutrophil to Lymphocyte Ratio for Survival Prediction of Bladder Cancer Patients

“…In addition, focal tumor immune responses show possible association with the systemic immune responses in cancer patients (25,27). Studies show that changes in systemic inflammation environment, such as NLR, can be a useful biomarker for predicting the survival of cancer patients (25,28,29).…”

Validation of the importance of neutrophil-to-lymphocyte ratio in non-muscle invasive bladder cancer

“…In the era of numerous genetic prognostic factors in bladder cancer [25][26][27][28], there is an urgent need for easily accessible, affordable, and widely interpretable biomarkers for current practice. The Neutrophil-to-lymphocyte Ratio proves to have all these benefits [29][30][31].…”