title: Prognostic impact of pretreatment neutrophil-to-lymphocyte ratio in castration-resistant prostate cancer patients treated with first-line docetaxel.
abstract: BACKGROUND
  The neutrophil-to-lymphocyte ratio (NLR), a measure of systemic inflammatory response, has been associated with poor outcome in several solid tumors, including prostate cancer. We retrospectively investigated the prognostic role of pretreatment NLR in metastatic castration-resistant prostate cancer (mCRPC) patients treated with first-line docetaxel.
  
  
  METHODS
  All CRPC patients treated with first-line docetaxel at two Italian institutions, with available data about baseline neutrophil and lymphocyte values, were included in this retrospective analysis. Patients were divided in two groups according to NLR ratio (low NLR: ≤3; high NLR: >3). Outcome measures were progression-free (PFS) and overall survival (OS), measured from the start of docetaxel treatment. Univariate and multivariate analysis (adjusting for baseline prostate-specific antigen, alkaline phosphatase, lactate dehydrogenase, hemoglobin, albumin, performance status, use of opioids and presence of visceral disease) were performed.
  
  
  RESULTS
  One hundred and seventy-nine patients treated between 2004 and 2016 were analyzed and 110 had information about pretreatment NLR. Forty-six patients (42%) had low NLR and 64 (58%) had high NLR. Median PFS was 8.8 months in patients with low NLR versus 7.3 months in those with high NLR [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.75-1.69, p = .58]. Median OS was 34.9 months in patients with low NLR versus 20.2 months in those with high NLR (HR 1.85, 95% CI 1.07-3.19, p = .02). At multivariate analysis, NLR confirmed an independent impact on OS (HR 3.16, 95% CI 1.50-6.65, p = .002).
  
  
  CONCLUSIONS
  In this retrospective series, metastatic CRPC patients who started first-line docetaxel with a low pretreatment NLR had a significantly better survival. In addition to known prognostic factors, NLR can be useful to improve prognostic evaluation of patients in this setting.
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Buttigliero
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pisano
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tucci
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vignani
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bertaglia
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Iaconis
authors.affiliation: b Oncology Unit , SS Antonio e Biagio e Cesare Arrigo Hospital , Alessandria , Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Guglielmini
authors.affiliation: b Oncology Unit , SS Antonio e Biagio e Cesare Arrigo Hospital , Alessandria , Italy.
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Giorgio V
authors.initials: GV
authors.lastname: Scagliotti
authors.affiliation: a Division of Medical Oncology, Department of Oncology , University of Turin, San Luigi Gonzaga Hospital , Turin , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D016016:Proportional Hazards Models; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality; D012189:Retrospective Studies; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel