Neutrophil and Lymphocyte Counts as Clinical Markers for Stratifying Low-Risk Prostate Cancer.
Appropriate patient selection for active surveillance is challenging.Our study of 217 patients demonstrated that the preoperative absolute neutrophil and lymphocyte counts were better predictors of aggressive oncologic features than were the neutrophil-to-lymphocyte ratio in the assessment of low-risk prostate cancer patients. Our findings suggest that routine hematologic workup could be used to further stratify low-risk prostate cancer patients.


BACKGROUND
The neutrophil-to-lymphocyte ratio (NLR) has emerged as a ubiquitous prognostic biomarker in cancer-related inflammation, specifically in patients with metastatic castration-resistant prostate cancer (PCa). We evaluated the clinical utility of the preoperative NLR, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) as a risk stratification tool for patients with low-risk PCa.


METHODS
We identified 217 low-risk PCa patients with preoperative hematologic data who had met the criteria for active surveillance but had undergone robot-assisted radical prostatectomy at our institution from 2006 to 2015. Logistic regression models were constructed to determine whether the baseline NLR, ANC, and ALC were associated with upstaging, upgrading, and biochemical recurrence (BCR). Survival analyses were performed using the Kaplan-Meier method.


RESULTS
On multivariate analysis, a higher prostate-specific antigen level (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.148-2.104), a greater number of positive cores (OR, 2.098; 95% CI, 1.043-2.104), and a higher ALC (OR, 4.311; 95% CI, 1.258-14.770) were associated with upstaging. More importantly, the 5-year biochemical recurrence-free survival was significantly lower in the high ANC group (ANC > 4.0 × 10(9)/L) compared with that of the low ANC group (P = .011). The NLR was not associated with upstaging, upgrading, or BCR in our study cohort (P = .368, P = .573, and P = .504, respectively). The only significant association with upgrading was patient age (OR, 1.106; 95% CI, 1.043-1.173).


CONCLUSIONS
NLR was not useful in predicting adverse pathologic outcomes in our patients with low-risk PCa. However, relative neutrophilia and lymphocytosis might indicate an early manifestation of harboring a more aggressive PCa.
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ.
Young Suk
YS
Kwon
Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Christopher Sejong
CS
Han
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Sungkyunkwan University School of Medicine, Seoul, Korea.
Ji Woong
JW
Yu
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ.
Sinae
S
Kim
Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Parth
P
Modi
Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Rachel
R
Davis
Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Ji Hae
JH
Park
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ.
Paul
P
Lee
Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
Yun-Sok
YS
Ha
Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
Wun-Jae
WJ
Kim
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ; Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: kimiy@cinj.rutgers.edu.
Isaac Yi
IY
Kim
D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000276:immunology* / Q000401:mortality; D009504:Neutrophils / Q000276:immunology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality
C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
Active surveillance; Neutrophil-to-lymphocyte ratio; Pathological outcome; Prostate cancer; Radical prostatectomy