title: Simple prognostic score for metastatic castration-resistant prostate cancer with incorporation of neutrophil-to-lymphocyte ratio.
abstract: BACKGROUND
  The neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, has been reported to be a poor prognostic indicator in prostate cancer. Here we explore the use of the NLR to establish a simple prognostic score for men with metastatic castration-resistant prostate cancer (mCRPC) treated with docetaxel.
  
  
  METHODS
  In the training cohort, the NLR and other known prognostic variables were evaluated among a cohort of chemotherapy-naïve patients treated with thrice-weekly docetaxel at the Princess Margaret Cancer Centre. Significant prognostic variables identified by univariable Cox regression were evaluated by the area under the receiver operating characteristic curves. Multivariable Cox regression was then used to derive a prognostic score where 1 risk point was assigned for each significant variable. The model was externally validated in a cohort of patients treated at the Royal Marsden.
  
  
  RESULTS
  Three hundred fifty-seven patients were analyzed in the training cohort. Median age was 71 years, 12% had liver metastasis, and median overall survival (OS) was 14.7 months. Liver metastases, hemoglobin <12 g/dL, alkaline phosphatase >2.0× upper limit of normal (ULN), lactate dehydrogenase >1.2× ULN, and NLR >3 were associated with significantly worse OS in multivariable analysis. Four risk categories were subsequently established with 0, 1, 2, and 3-5 points. Two-year OS rates for these categories were 43%, 37%, 12%, and 3%, respectively. Area under the curve for the training cohort was 0.78 (95% CI, 0.72-0.84) compared with 0.66 (95% CI, 0.58-0.74) for the 215 patients in the validation cohort.
  
  
  CONCLUSIONS
  This simple risk score provides good prognostic and discriminatory accuracy for men with mCRPC.
authors.affiliation: Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Arnoud J
authors.initials: AJ
authors.lastname: Templeton
authors.forename: Carmel
authors.initials: C
authors.lastname: Pezaro
authors.forename: Aurelius
authors.initials: A
authors.lastname: Omlin
authors.forename: Mairéad G
authors.initials: MG
authors.lastname: McNamara
authors.forename: Raya
authors.initials: R
authors.lastname: Leibowitz-Amit
authors.forename: Francisco E
authors.initials: FE
authors.lastname: Vera-Badillo
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Attard
authors.forename: Johann S
authors.initials: JS
authors.lastname: de Bono
authors.forename: Ian F
authors.initials: IF
authors.lastname: Tannock
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077143:Docetaxel; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D017430:Prostate-Specific Antigen
keywords: castration-resistant prostate cancer, neutrophil-to-lymphocyte ratio; prognosis; score