The prognostic power of inflammatory indices and clinical factors in metastatic castration-resistant prostate cancer patients treated with radium-223 (BIO-Ra study)

Abstract

Purpose To combine peripheral blood indices and clinical factors in a prognostic score for metastatic castration-resistant prostate cancer (mCRPC) patients treated with radium-223 dichloride ([223Ra]RaCl2). Patients and methods Baseline neutrophil-to-lymphocyte ratio (NLR), derived NLR (donor), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), Eastern Cooperative Oncology Group performance status (ECOG PS), Gleason score (GS) group, number of bone metastases, prostate-specific antigen (PSA), alkaline phosphatase (ALP), line of therapy, previous chemotherapy, and the presence of lymphadenopathies were collected from seven Italian centers between 2013 and 2020. Lab and clinical data were assessed in correlation with the overall survival (OS). Inflammatory indices were then included separately in the multivariable analyses with the prognostic clinical factors. The model with the highest discriminative ability (c-index) was chosen to develop the BIO-Ra score. Results Five hundred and nineteen mCRPC patients (median OS: 19.9 months) were enrolled. Higher NLR, dNLR, PLR, and SII and lower LMR predicted worse OS (all with a p < 0.001). The multivariable model including NLR, ECOG PS, number of bone metastases, ALP, and PSA (c-index: 0.724) was chosen to develop the BIO-Ra score. Using the Schneeweiss scoring system, the BIO-Ra score identified three prognostic groups (36%, 27.3%, and 36.6% patients, respectively) with distinct median OS (31, 26.6, and 9.6 months, respectively; hazard ratio: 1.62, p = 0.008 for group 2 vs. 1 and 5.77, p < 0.001 for group 3 vs. 1). Conclusions The BIO-Ra score represents an easy and widely applicable tool for the prognostic stratification of mCRPC patients treated with [223Ra]RaCl2 with no additional costs.

Association Between Pre-Treatment and Post-Treatment 3-Month Red Cell Distribution Width with Three-Year Prognosis of Prostate Cancer

“… 22–24 Cho et al 23 reported that the lymphocyte-to-monocyte ratio is a predictor of clinically significant prostate cancer on prostate biopsy. Bauckneht et al 24 also found that a higher neutrophil-to-lymphocyte ratio and systemic inflammation index predicted worse OS in patients with prostate cancer. RDW, as an inflammation biomarker, has been linked to poor outcomes in patients with different types of cancer.…”

“…20,21 Many research groups have investigated the predictive and prognostic roles of peripheral blood inflammatory parameters in prostate cancer. [22][23][24] Cho et al 23 reported that the lymphocyte-to-monocyte ratio is a predictor of clinically significant prostate cancer on prostate biopsy. Bauckneht et al 24 also found that a higher neutrophil-to-lymphocyte ratio and systemic inflammation index predicted worse OS in patients with prostate cancer.…”

Opportunistic skeletal muscle metrics as prognostic tools in metastatic castration-resistant prostate cancer patients candidates to receive Radium-223

“…However, given the observed prognostic value of the increased FDG uptake in the sarcopenic SM, we presume that this phenomenon might also involve the occurrence of SM inflammation. Indeed, several previous studies highlighted the occurrence of a systemic inflamed state in heavily pre-treated mCRPC [ 11 , 17 , 39 , 50 ]. On the other hand, a direct causal role of inflammation has been shown in the age-related decline of SM mass [ 51 ].…”

Construction of Bone Metastasis-Specific Regulation Network Based on Prognostic Stemness-Related Signatures in Prostate Cancer

“…IL-6, a biomarker of prostate inflammation, was reported to contribute to the transition to CRRC through accessory activation of androgen receptors [ 64 ]. Furthermore, inflammatory indices have shown stratification efficacy in predicting prognosis of mCRPC patients treated with radiation [ 65 ]. Besides, the reduction of molecular biomarkers, including CD34 and VEGF, was observed in patients treated with 5 α -reductase inhibitor before bipolar transurethral resection of the prostate (B-TURP) [ 66 ].…”