title: Role of neutrophil-to-lymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance.
abstract: BACKGROUND
  Active surveillance (AS) is an option for management of low-risk prostate cancer (PCa). However, grade and stage progression is an important consideration. Neutrophil-to-lymphocyte ratio (NLR) is a useful marker of cancer-related inflammation. In this study, we aimed to identify the roles of neutrophil count (NC), lymphocyte count (LC), and NLR to predict Gleason score (GS) upgrading, disease upstaging, and biochemical recurrence rates (BCR) in low-risk PCa patients.
  
  
  METHODS
  We retrospectively evaluated data of 210 low-risk PCa patients eligible for AS, but who underwent radical prostatectomy. The roles of NC, LC, and NLR on the GS upgrading, disease upstaging, and BCR rates were investigated. Univariate and multivariate models were used to determine the effect of these parameters.
  
  
  RESULTS
  There were 104 and 106 patients in the NLR <2.5 and NLR ≥2.5 groups, respectively. GS upgrading in the NLR ≥2.5 group was more common than in the NLR<2.5 group (p=0.04). The NLR ≥2.5 group had significantly higher GS (8-10; p=0.03). With regard to NLR, the groups were found to have similar rates of disease upstaging (9/104 in NLR <2.5 vs. 16/106 in NLR ≥2.5; p=0.200). BCR rates were also significantly different between groups (p=0.033). NC an LC were not found to be associated with GS upgrading, disease upstaging, or BCR.
  
  
  CONCLUSIONS
  NLR is a predictor of GS upgrading and BCR, but not disease upstaging in patients with low-risk PCa. Furthermore, higher NLR was found to be associated with higher GS PCa. NLR is a cost-effective and easily accessible tool that can be used in the decision-making process for treatment of low-risk PCa cases.
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet Ilker
authors.initials: MI
authors.lastname: Gokce
authors.affiliation: Department of Urology, Ufuk University School of Medicine, Ankara, Turkey.
authors.forename: Semih
authors.initials: S
authors.lastname: Tangal
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Hamidi
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Suer
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Muhammed Arif
authors.initials: MA
authors.lastname: Ibis
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Beduk