Systemic Immune-Inflammation Index Predicts the Clinical Outcome in Patients with mCRPC Treated with Abiraterone

Abstract

Background: A systemic immune-inflammation index (SII) based on neutrophil (N), lymphocyte (L), and platelet (P) counts has shown a prognostic impact in several solid tumors. The aim of this study is to evaluate the prognostic role of SII in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone post docetaxel.Patients and Methods: We retrospectively reviewed consecutive mCRPC patients treated with abiraterone after docetaxel in our Institutions. X-tile 3.6.1 software, cut-off values of SII, neutrophil-to-lymphocyte ratio (NLR) defined as N/L and platelets-to-lymphocyte ratio (PLR) as P/L. Overall survival (OS) and their 95% Confidence Intervals (95% CI) was estimated by the Kaplan-Meier method and compared with the log-rank test. The impact of SII, PLR, and NLR on overall survival (OS) was evaluated by Cox regression analyses and on prostate-specific antigen (PSA) response rates were evaluated by binary logistic regression.Results: A total of 230 mCRPC patients treated abiraterone were included. SII ≥ 535, NLR ≥ 3 and PLR ≥ 210 were considered as elevated levels (high risk groups. The median OS was 17.3 months, 21.8 months in SII < 535 group and 14.7 months in SII ≥ 535 (p < 0.0001). At univariate analysis Eastern Cooperative Oncology Group (ECOG) performance status, previous enzalutamide, visceral metastases, SII, NLR, and PLR predicted OS. In multivariate analysis, ECOG performance status, previous enzalutamide, visceral metastases, SII, and NLR remained significant predictors of OS [hazard ratio (HR) = 5.08, p < 0.0001; HR = 2.12, p = 0.009, HR = 1.77, 95% p = 0.012; HR = 1.80, p = 0.002; and HR = 1.90, p = 0.001, respectively], whereas, PLR showed a borderline ability only (HR = 1.41, p = 0.068).Conclusion: SII and NLR might represent an early and easy prognostic marker in mCRPC patients treated with abiraterone. Further studies are needed to better define their impact and role in these patients.

Baseline neutrophil‑to‑lymphocyte ratio predicts the prognosis of castration‑resistant prostate cancer treated with abiraterone acetate

“…With regard to AA, several studies have reported a correlation with the NLR in patients with metastatic CRPC. Similar to the result of our study, these studies showed that low baseline NLR was shown to be associated with improved survival; and also low baseline platelet-lymphocyte ratio was similarly associated with better survival (18,23,24). These findings show that the systemic immune system has an impact on the prognosis of CRPC patients, including those treated with AA.…”

Prognostic value of platelet to lymphocyte ratio in predicting survival of patients with metastatic castration‐resistant prostate cancer receiving abiraterone acetate: An evidence‐based case report and review of literature

“…A high PLR has been shown to predict poor prognoses in various cancers such as hepatocellular carcinoma, breast cancer, urological cancers, and pancreatic cancer . This is consistent with the results from both included studies which show that patients with a higher PLR had significantly lower overall survival rates, demonstrating the prognostic value of this laboratory marker in mCRPC patients treated with abiraterone . Based on these findings, our patient's PLR, which was 320.8, should be associated with a poorer overall survival.…”

“…Lolli et al conducted a study with 230 mCRPC patients, evaluating the prognostic role of systemic immune‐inflammation index (SII) in mCRPC patients who received abiraterone with previous docetaxel treatment. Lolli et al also found that a high PLR (>150) is significantly associated with shorter overall survival (14.4 vs 19.0 months, P = 0.002), with a hazard ratio (HR) of 1.68 (1.20‐2.35), analyzed by cox proportional hazard regression models (Table ).…”

Role of systemic inflammatory response markers in urological malignancy

“…A summary of 15 recent studies investigating the prognostic role of NLR in PC is shown in Table . Six studies investigated the prognostic value of NLR in patients who underwent radical prostatectomy for PC; five studies evaluated the preoperative value, and the remaining studies evaluated postoperative values.…”

“…Lolli et al . analyzed the association of baseline NLR and change in NLR at 4 weeks after treatment with survival in patients who received abiraterone treatment for mCRPC . High baseline NLR was significantly associated with shorter OS ( P < 0.001).…”