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Elevated preoperative neutrophil–lymphocyte ratio predicts upgrading at radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 21, pages 100–105 (2018)Cite this article

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Abstract

Background

Neutrophil–lymphocyte ratio (NLR) is a widely used, representative marker of systemic inflammatory response within the body. NLR can be calculated from simple, inexpensive peripheral blood samples. High NLR is a negative prognostic factor in a variety of malignancies including urological tumors. In this study, we aim to assess the prognostic value of preoperative neutrophil- lymphocyte ratio (NLR) in patients treated with radical prostatectomy (RP) for localized prostate cancer (PCa).

Materials and methods

Records of 7426 patients were retrospectively analyzed from prospectively collected datasets. A cut-off point of 3 was taken for NLR based on ROC analyses and previous literature.

Results

23% (n = 1707) of patients had an NLR of ≥3. Patients with NLR ≥3 were more likely to harbor unfavorable pathological features such as higher biopsy Gleason score (GS), higher RP GS, higher rates of extra capsular extension, nodal involvement (all p < 0.001) and positive surgical margins (p = 0.002). On multivariable analyses, NLR ≥ 3 was associated with higher RP GS (OR 2.32; p < 0.001), seminal vesicle invasion (OR 1.60; p < 0.001) and nodal involvement (OR 1.43; p < 0.001). On multivariable analyses, NLR ≥ 3 was significantly associated with GS upgrading at RP (OR 1.39 p < 0.001). During a median follow up of 45 months, NLR ≥ 3 was associated with higher risk of BCR (p = 0.001). However, on multivariable Cox regression analysis such association was not shown (HR 0.86; p = 0.4).

Conclusion

Preoperative NLR ≥ 3 was associated with aggressive PCa, such as upgrading at RP. Even though its effect on clinical-decision making seems to be limited when all clinical and pathological confounders are taken into account, preoperative NLR may still be useful in selected patients to identify aggressive PCa helping patient selection for active surveillance protocols. Conversely, it does not predict BCR when adjusted for the effect of pathological features.

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Authors and Affiliations

  1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Mehmet Özsoy, Marco Moschini, Harun Fajkovic, Francesco Soria, Christian Seitz, Tobias Klatte, Kilian Gust, Gero Kramer & Shahrokh F. Shariat

  2. Karl Landsteiner Society, Urology and Andrology, Vienna, Austria

    Mehmet Özsoy, Harun Fajkovic, Christian Seitz, Tobias Klatte & Shahrokh F. Shariat

  3. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Marco Moschini & Alberto Briganti

  4. Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy

    Francesco Soria

  5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada

    Pierre I. Karakiewicz

  6. Department of Urology, Pitié-Salpétrière Hospital, University Paris, Paris, France

    Morgan Roupret

  7. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  8. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

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  1. Mehmet Özsoy
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Corresponding author

Correspondence to Shahrokh F. Shariat.

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Özsoy, M., Moschini, M., Fajkovic, H. et al. Elevated preoperative neutrophil–lymphocyte ratio predicts upgrading at radical prostatectomy. Prostate Cancer Prostatic Dis 21, 100–105 (2018). https://doi.org/10.1038/s41391-017-0015-8

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