title: Pretreatment neutrophil-to-lymphocyte ratio in metastatic castration-resistant prostate cancer patients treated with ketoconazole: association with outcome and predictive nomogram.
abstract: BACKGROUND
  The neutrophil-to-lymphocyte ratio (NLR), an inflammation marker, is prognostic in several cancers. We assessed the association between the pretreatment NLR and outcome of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with the CYP17 inhibitor ketoconazole.
  
  
  METHODS
  This was an international, retrospective study of 156 mCRPC patients treated with ketoconazole. The independent effect of the pretreatment NLR and factors associated with treatment outcome were determined by multivariate analysis.
  
  
  RESULTS
  Seventy-eight patients (50%) had a ≥50% decline in prostate-specific antigen (PSA). The median progression-free survival (PFS) time was 8 months. Excluded from the analysis were 23 patients without available data on their NLR and those with a recent health event or treatment associated with a blood count change. Sixty-two patients (47%) had a pretreatment NLR >3. Risk factors associated with the PFS outcome were a pretreatment NLR >3 and PSA doubling time (PSADT) <3 months and a prior response to a gonadotropin-releasing hormone agonist of <24 months or to an antiandrogen of <6 months. The number of risk factors was used to form a predictive nomogram by patient categorization into favorable (zero or one factor), intermediate (two factors), and poor (three or four factors) risk groups.
  
  
  CONCLUSIONS
  In mCRPC patients treated with ketoconazole, the pretreatment NLR and PSADT, and prior response to androgen-deprivation therapy, may be associated with the PFS time and used to form a risk stratification predictive nomogram.
authors.affiliation: Genitourinary Oncology Service, Institute of Oncology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar-Saba, Israel. danielkeizman@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Keizman
authors.forename: Maya
authors.initials: M
authors.lastname: Gottfried
authors.forename: Maya
authors.initials: M
authors.lastname: Ish-Shalom
authors.forename: Natalie
authors.initials: N
authors.lastname: Maimon
authors.forename: Avivit
authors.initials: A
authors.lastname: Peer
authors.forename: Avivit
authors.initials: A
authors.lastname: Neumann
authors.forename: Eli
authors.initials: E
authors.lastname: Rosenbaum
authors.forename: Svetlana
authors.initials: S
authors.lastname: Kovel
authors.forename: Roberto
authors.initials: R
authors.lastname: Pili
authors.forename: Victoria
authors.initials: V
authors.lastname: Sinibaldi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carducci
authors.forename: Hans
authors.initials: H
authors.lastname: Hammers
authors.forename: Mario A
authors.initials: MA
authors.lastname: Eisenberger
authors.forename: Avishay
authors.initials: A
authors.lastname: Sella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D018572:Disease-Free Survival; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use*; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology; D049451:Nomograms; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013254:Steroid 17-alpha-Hydroxylase / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone; D013254:Steroid 17-alpha-Hydroxylase; D017430:Prostate-Specific Antigen; D007654:Ketoconazole