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Evaluation of neutrophil-to-lymphocyte ratio as a prognostic indicator in a Singapore cohort of patients with clinically localized prostate cancer treated with prostatectomy

  • Yadong LuEmail author
  • Hong Hong Huang
  • Weber Kam On Lau
Original Article
  • 43 Downloads

Abstract

Purpose

Recent evidence suggests that the presence of a systemic inflammatory response plays an important role in the progression of several solid tumors. The neutrophil-to-lymphocyte ratio (NLR) has been proposed as easily assessable markers of systemic inflammation and has been shown to represent a prognostic marker in prostate cancer in previous studies.

Methods

Data from 668 patients with localized prostate cancer treated with prostatectomy (open and robot assisted) in Singapore General Hospital from 1998 to 2014 were analyzed. Correlation between NLR and histopathological status was analyzed. Association between NLR and distant metastases-free survival (MFS), cancer-specific survival (CSS), overall survival (OS), and biochemical disease-free survival (BDFS) was assessed.

Results

NLR was not significantly correlated with histopathological status, including Gleason score (≤ 6 versus 7 versus ≥ 8, p = 0.159), lymph node metastasis (negative versus positive, p = 0.159), or surgical margin status (negative versus positive, p = 0.494). NLR was categorized into two groups (< median and ≥ median, median = 2.09) and NLR ≥ 2.09 was not a prognostic factor for decreased MFS (p = 0.609), CSS (p = 0.302), OS (p = 0.722) and BDFS (p = 0.589). No difference was observed for NLR even in high-risk subgroup patients compared to the rest (p = 0.058). The area under the ROC curve (AUC) of NLR as a prognosticator for biochemical recurrence was only 0.53.

Conclusion

Our findings indicate that pre-treatment NLR may not predict prognosis in patients with localized prostate cancer treated with prostatectomy in an Asian cohort.

Keywords

Prostate cancer Radical prostatectomy Neutrophil-to-lymphocyte ratio Prognosis 

Notes

Author contributions

YL: Project development, Data Collection, Data Analysis, Manuscript writing; HHH: Data collection and Data Analysis; WLKO: Project development, Manuscript writing and amendment.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90CrossRefGoogle Scholar
  2. 2.
    Chen R, Ren S, Chinese Prostate Cancer C, Yiu MK, Fai NC, Cheng WS, Ian LH, Naito S, Matsuda T, Kehinde E et al (2017) Prostate cancer in Asia: a collaborative report. Asian J Urol 1(1):15–29CrossRefGoogle Scholar
  3. 3.
    Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B et al (2014) Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 106(6):dju124CrossRefGoogle Scholar
  4. 4.
    Templeton AJ, Pezaro C, Omlin A, McNamara MG, Leibowitz-Amit R, Vera-Badillo FE, Attard G, de Bono JS, Tannock IF, Amir E (2014) Simple prognostic score for metastatic castration-resistant prostate cancer with incorporation of neutrophil-to-lymphocyte ratio. Cancer 120(21):3346–3352CrossRefGoogle Scholar
  5. 5.
    Nuhn P, Vaghasia AM, Goyal J, Zhou XC, Carducci MA, Eisenberger MA, Antonarakis ES (2014) Association of pretreatment neutrophil-to-lymphocyte ratio (NLR) and overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with first-line docetaxel. BJU Int 114(6b):E11–E17CrossRefGoogle Scholar
  6. 6.
    Gu X, Gao X, Li X, Qi X, Ma M, Qin S, Yu H, Sun S, Zhou D, Wang W (2016) Prognostic significance of neutrophil-to-lymphocyte ratio in prostate cancer: evidence from 16,266 patients. Sci Rep 6:22089CrossRefGoogle Scholar
  7. 7.
    Yin X, Xiao Y, Li F, Qi S, Yin Z, Gao J (2016) Prognostic role of neutrophil-to-lymphocyte ratio in prostate cancer: a systematic review and meta-analysis. Medicine (Baltimore) 95(3):e2544CrossRefGoogle Scholar
  8. 8.
    Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ (2012) A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer 107(4):695–699CrossRefGoogle Scholar
  9. 9.
    Kawahara T, Fukui S, Sakamaki K, Ito Y, Ito H, Kobayashi N, Izumi K, Yokomizo Y, Miyoshi Y, Makiyama K et al (2015) Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy. Oncotarget 6(31):32169–32176CrossRefGoogle Scholar
  10. 10.
    van Soest RJ, Templeton AJ, Vera-Badillo FE, Mercier F, Sonpavde G, Amir E, Tombal B, Rosenthal M, Eisenberger MA, Tannock IF et al (2015) Neutrophil-to-lymphocyte ratio as a prognostic biomarker for men with metastatic castration-resistant prostate cancer receiving first-line chemotherapy: data from two randomized phase III trials. Ann Oncol 26(4):743–749CrossRefGoogle Scholar
  11. 11.
    Epstein JI, Allsbrook WC, Amin MB, Egevad LL, Committee IG (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242CrossRefGoogle Scholar
  12. 12.
    Maeda Y, Kawahara T, Koizumi M, Ito H, Kumano Y, Ohtaka M, Kondo T, Mochizuki T, Hattori Y, Teranishi J et al (2016) Lack of an association between neutrophil-to-lymphocyte ratio and PSA failure of prostate cancer patients who underwent radical prostatectomy. Biomed Res Int 2016:6197353CrossRefGoogle Scholar
  13. 13.
    Mantovani A, Allavena P, Sica A, Balkwill F (2008) Cancer-related inflammation. Nature 454(7203):436–444CrossRefGoogle Scholar
  14. 14.
    Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420(6917):860–867CrossRefGoogle Scholar
  15. 15.
    Jaiswal M, LaRusso NF, Burgart LJ, Gores GJ (2000) Inflammatory cytokines induce DNA damage and inhibit DNA repair in cholangiocarcinoma cells by a nitric oxide-dependent mechanism. Cancer Res 60(1):184–190Google Scholar
  16. 16.
    Kawahara T, Ishiguro H, Hoshino K, Teranishi J, Miyoshi Y, Kubota Y, Uemura H (2010) Analysis of NSAID-activated gene 1 expression in prostate cancer. Urol Int 84(2):198–202CrossRefGoogle Scholar
  17. 17.
    Ishiguro H, Kawahara T (2014) Nonsteroidal anti-inflammatory drugs and prostatic diseases. Biomed Res Int 2014:436123CrossRefGoogle Scholar
  18. 18.
    Gomez D, Morris-Stiff G, Toogood GJ, Lodge JP, Prasad KR (2008) Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 97(6):513–518CrossRefGoogle Scholar
  19. 19.
    Gunter MJ, Stolzenberg-Solomon R, Cross AJ, Leitzmann MF, Weinstein S, Wood RJ, Virtamo J, Taylor PR, Albanes D, Sinha R (2006) A prospective study of serum C-reactive protein and colorectal cancer risk in men. Cancer Res 66(4):2483–2487CrossRefGoogle Scholar
  20. 20.
    Brandau S, Dumitru CA, Lang S (2013) Protumor and antitumor functions of neutrophil granulocytes. Semin Immunopathol 35(2):163–176CrossRefGoogle Scholar
  21. 21.
    Tazzyman S, Lewis CE, Murdoch C (2009) Neutrophils: key mediators of tumour angiogenesis. Int J Exp Pathol 90(3):222–231CrossRefGoogle Scholar
  22. 22.
    Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH, Lin DW (2010) Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol 183(6):2213–2218CrossRefGoogle Scholar
  23. 23.
    Servoll E, Vlatkovic L, Saeter T, Nesland JM, Axcrona U, Waaler G, Axcrona K (2014) The length of a positive surgical margin is of prognostic significance in patients with clinically localized prostate cancer treated with radical prostatectomy. Urol Int 93(3):289–295CrossRefGoogle Scholar
  24. 24.
    Zhang GM, Zhu Y, Ma XC, Qin XJ, Wan FN, Dai B, Sun LJ, Ye DW (2015) Pretreatment neutrophil-to-lymphocyte ratio: a predictor of advanced prostate cancer and biochemical recurrence in patients receiving radical prostatectomy. Medicine (Baltimore) 94(41):e1473CrossRefGoogle Scholar
  25. 25.
    Kwon YS, Han CS, Yu JW, Kim S, Modi P, Davis R, Park JH, Lee P, Ha YS, Kim WJ et al (2016) Neutrophil and lymphocyte counts as clinical markers for stratifying low-risk prostate cancer. Clin Genitourin Cancer 14(1):e1–e8CrossRefGoogle Scholar
  26. 26.
    Gooden MJ, de Bock GH, Leffers N, Daemen T, Nijman HW (2011) The prognostic influence of tumour-infiltrating lymphocytes in cancer: a systematic review with meta-analysis. Br J Cancer 105(1):93–103CrossRefGoogle Scholar
  27. 27.
    Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S (2012) Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 5(1):2CrossRefGoogle Scholar
  28. 28.
    McGinley KF, Tay KJ, Moul JW (2016) Prostate cancer in men of African origin. Nat Rev Urol 13(2):99–107CrossRefGoogle Scholar
  29. 29.
    Rebbeck TR (2017) Prostate cancer genetics: variation by race, ethnicity, and geography. Semin Radiat Oncol 27(1):3–10CrossRefGoogle Scholar
  30. 30.
    Liu M, Shi X, Wang J, Xu Y, Wei D, Zhang Y, Yang K, Wang X, Liang S, Chen X et al (2015) Association of FOXP4 gene with prostate cancer and the cumulative effects of rs4714476 and 8q24 in Chinese men. Clin Lab 61(10):1491–1499Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologySingapore General HospitalSingaporeSingapore

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