The preoperative neutrophil‐to‐lymphocyte ratio is not a marker of prostate cancer characteristics but is an independent predictor of biochemical recurrence in patients receiving radical prostatectomy

• Published in: Cancer medicine (Malden, MA) Vol. 8; no. 3; pp. 1004 - 1012
• Main Authors: Cao, Zhi, Ji, Jin, Zhang, Chao, Wang, Fubo, Xu, Huan, Yu, Yongwei, Sun, Yinghao
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2019; John Wiley and Sons Inc; Wiley
• Subjects: Aged; AKT protein; Archives & records; Bias; biochemical recurrence; Biomarkers, Tumor - blood; Blood; Cancer surgery; Carcinogens; CD3 antigen; CD4 antigen; CD8 antigen; Clinical Cancer Research; Disease Progression; Humans; Hypotheses; Immunohistochemistry; Interferon; Lymphocytes; Lymphocytes - pathology; lymphocyte–neutrophil ratio; Male; Medical prognosis; Neoplasm Grading; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neutrophils; Neutrophils - pathology; Original Research; Pathology; Preoperative Care - methods; Prostate cancer; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; PTEN protein; Radiation therapy; radical prostatectomy; Retrospective Studies; Statistical analysis; Studies; Survival Rate; Tumor necrosis factor; Tumors; Urological surgery; lymphocyte-neutrophil ratio; prostate cancer; radical prostatectomy; biochemical recurrence
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.1984

The neutrophil‐to‐lymphocyte ratio (NLR) has been reported to be a prognostic marker in prostate cancer. In this study, we assessed the association between preoperative NLR and the clinicopathological characteristics, biomolecular features and prognosis of patients with localized prostate cancer treated with radical prostatectomy. A total of 994 subjects were retrospectively enrolled, and the histological specimens of 210 patients were retrieved for constructing a tissue microarray. Immunohistochemistry was then performed to assess the expression of AR, ERG, PTEN, p‐AKT, Bcl‐2, Beclin‐1, Ki‐67, CD3, CD4, CD8, IFN‐γ and TNF‐α. No significant differences in the NLR distributions among clinicopathological variables were observed (P > 0.05) when the original NLR data were utilized. When we dichotomized the NLR value into the high‐NLR group (NLR ≥ 2) and low‐NLR group (NLR < 2), we found that the patients in the high‐NLR group had more prostate capsule invasion (P = 0.047). Additionally, no significant correlation was found between the NLR and infiltrating CD3+ cells, the CD4/CD8 ratio, AR, ERG, PTEN, p‐AKT, Bcl‐2, Beclin‐1, Ki‐67, IFN‐γ or TNF‐α (P > 0.05). When we analyzed the data of patients without postoperative adjuvant hormone therapy or radiotherapy, univariate and multivariate survival analysis indicated that a high NLR was a predictor of better BCR‐free survival (P < 0.05). When analyzing the entire cohort, univariate survival analysis showed that the high‐NLR group had significantly poorer overall survival (P < 0.05). In conclusion, NLR cannot reflect prostate cancer characteristics or the local immune microenvironment, but a high NLR can serve as an independent predictor of better BCR. Previous studies reported the association between NLR and pathological characteristics of prostate cancer, and patients with preoperative high‐NLR had significantly poorer BCR‐free survival. This study contradicts these reports, and reports that there is no association between preoperative NLR and pathological features and representative molecules of biological function (eg. AR, ERG, PTEN, p‐AKT, Bcl‐2, Beclin‐1, Ki‐67) and the local microenvironment (eg. infiltrating CD3+ cells, the CD4/CD8 ratio,IFN‐γ and TNF‐α) of localized prostate cancer. Furthermore, it also reveals that a high NLR can serve as an independent predictor of better BCR. Additionally, univariate analysis indicated that a high NLR was associated with poor overall survival, but this correlation was not verified in the multivariate analysis. NLR, as a reliable, easily accessible and inexpensive biomarker, might benefit individual risk assessment and patient stratification.