Neutrophil and Lymphocyte Counts as Clinical Markers for Stratifying Low-Risk Prostate Cancer

Abstract

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 × 109/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.

Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance

“…The GS upgrading (32.8%) and disease upstaging (11.9%) rates of our cohort are concordant with the current literature and slightly higher than the cohort of Kwon et al 13 Also, BCR was observed in 30 of 210 (14.3%) of the patients, which is much higher than the cohort of Kwon et al (6 of 217 patients, 2.8%). This disparity may explain the higher systemic inflammation in our cohort and this might have reflected as increased NLR in patients with BCR.…”

“…For instance, tumour-infiltrating lymphocytes are needed in the early stages of cancers, whereas with increasing stage, systemic inflammation through the increased levels of neutrophils is needed. This has been supported by the findings from a recent study by Kwon et al 13 In another recent study, NLR prior to prostate biopsy was found to be associated with the presence of PCa and higher GS as well. 14 In this study, we aimed to identify the roles of neutrophil count (NC), lymphocyte count (LC), and NLR to predict disRole of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance ORIGINAL RESEARCH ease upgrading, disease upstaging, and biochemical recurrence rates (BCR) in a cohort of low-risk PCa patients eligible for AS, but who underwent radical prostatectomy.…”

“…The authors explained this by the hypothesis of significant involvement of tumour-infiltrating lymphocytes in the early phase of PCa. 13 Our results revealed that NLR was associated with GS upgrading and BCR, but neither NC nor LC were associated with any of the study endpoints. NLR and preoperative serum PSA levels were also found to be associated with GS upgrading in the multivariate analysis.…”

“…12 In a study in early-stage, lowrisk PCa patients, Kwon et al found that LC was associated with GS upgrading and NC was associated with BCR. 13 In their analysis, NLR was not associated with any of the study endpoints. The authors explained this by the hypothesis of significant involvement of tumour-infiltrating lymphocytes in the early phase of PCa.…”

Author reply: The neutrophil-to-lymphocyte ratio in clinical practice

“…In this study, Kwon et al found that lymphocyte count was associated with Gleason score upgrading and neutrophil count was associated with biochemical failure; NLR was not found to have association with any of the study endpoints. 8 Our group also investigated the results of low-risk cases in which the patients underwent radical prostatectomy. We found that NLR was associated with higher rates of Gleason score upgrading and high-grade prostate cancer cases, but not with disease upstaging (data not yet published).…”