Engin Kolukcu, Latif Mustafa Ozbek, Velid Unsal

Clinical significance of neutrophil-lymphocyte ratio in patients with low-risk prostate cancer

Aim: Active surveillance is a highly emphasized approach to low-risk prostate cancer. Upgrading and upstaging should be evaluatedcarefully in this strategic management. This study aimed to analyze the relationship of neutrophil-lymphocyte ratio (NLR) with these two clinical conditions.Materials and Methods: Demographic data, prostate-specific antigen (PSA) levels, prostate volumes, NLR, disease stages, andGleason scores of 59 low-risk prostate cancer patients who underwent radical prostatectomy and met active surveillance criteria were evaluated in our clinic. The patients were examined in four groups according to their postoperative pathology specimens. Accordingly, the patients with upgrading Group 1, while those without formed Group 2. Similarly, Group 3 consisted of the cases with upstaging and the patients with no upstaging were determined as Group 4.Results: Median age, PSA levels, prostate volumes, neutrophil and lymphocyte counts of the patients were 69.0 (63.0-72.0) years,7.24 (5.50-8.90) ng/dL, 65.0 (60.0-65.0) cc, 6.40 (4.87-8.73) K/uL, and 2.50 (1.60-3.10) K/uL, respectively. Prostate volume and age distribution were similar between the groups. PSA levels were higher in Group 1 and Group 3 than those in Group 2 and Group 4 (p=0.012 and p=0.049, respectively). NLR was 3.54 (1.89-5.45) and 1.94 (1.68-3.76) in groups 1 and 2, respectively. Although these values were low in Group 2, a statistically significant relationship could not be established (p=0.266). NLR in groups 3 and 4 was 2.46 (1.52-5.45) and 2.24 (1.68-4.35), respectively. The NLR level in Group 3 was high; however, the difference was not statistically significant (p=0.953).Conclusion: The study let us to conclude that NLR alone is not sufficient to predict the clinical course of patients with low-riskprostate cancer.

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1. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence
and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2018;68:394-424.
2. Efesoy O, Bozlu M, Cayan S, et al. Complications of
Transrectal Ultrasound-Guided 12-core Prostate
Biopsy: A Single Center Experience With 2049 Patients.
Turk J Urol 2013;39:6-11.
3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020.
CA Cancer J Clin 2020;70:7-30.
4. Tinay I, Turkeri L. Active surveillance for localized prostate cancer. Bull Urooncol 2012;11:114-8.
5. Gokce MI, Tangal S, Hamidi N, et al. 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. Can
Urol Assoc J 2016;10:383-7.
6. Behbahani TE, Ellinger J, Caratozzolo DG, et al. Pathological Outcomes of Men Eligible for Active
Surveillance After Undergoing Radical Prostatectomy:
Are Results Predictable? Clin Genitourin Cancer
2012;10:32-6.
7. Mimeault M, Batra SK. Development of animal models
underlining mechanistic connections between
prostate inflammation and cancer. World J Clin Oncol
2013;4:4-13.
8. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate
and Longer Term Outcomes From a Prospective
Active-Surveillance Program for Favorable-Risk
Prostate Cancer. J Clin Oncol 2015;33:3379-85.
9. Hwang I, Lim D, Jeong YB, et al. Upgrading and
Upstaging of Low-Risk Prostate Cancer Among
Korean Patients: A Multicenter Study. Asian J Androl
2015;17:811-4.
10. Ipek C, Bugday MS, Kucuk EV. Evaluation of Post-
Operational Complications of Robotic Radical
Prostatectomy in Learning Curve. Van Tıp Derg
2015;22:230-4.
11. Ozkok S. Possible problems and solutions after
radiation therapy for prostate cancer. Bull Urooncol
2011;10:98-102.
12. Soydan H, Malkoc E, Dursun F, et al. Radical
Prostatectomy and Active Surveillance in Prostate
Cancer; The Evaluation of Erectile Function and
Depression. J Clin Anal Med 2013;4:189-2.
13. Wilt JT, Brawer MK, Jones KM, et al. Radical
prostatectomy versus observation for localized
prostate cancer. N Engl J Med 2012;367:203-13.
14. Izol V, Akdogan N. Active Surveillance in Prostate
Cancer. Bull Urooncol 2017;16:127-32.
15. Sooriakumaran P, Srivastava A, Christos P, et al.
Predictive models for worsening prognosis in potential
candidates for active surveillance of presumed low-
risk prostate cancer. Int Urol Nephrol 2012;44:459-70.
16. Conti SL, Dall’era M, Fradet V, et al. Pathological
outcomes of candidates for active surveillance of
prostate cancer. J Urol 2009;181:1628-33.
17. Ferro M, Musi G, Serino A, et al. Neutrophil, Platelets,
and Eosinophil to Lymphocyte Ratios Predict Gleason
Score Upgrading in Low-Risk Prostate Cancer
Patients. Urol Int 2019;102:43-50.
18. Yildirim I. The Role of Inflammation In Cancer
Development. Eskişehir Technical University Journal
of Science and Technology C- Life Sciences and
Biotechnology 2019;8:121-40.
19. Eskiizmir G. Tumor Microenvironment in Head
and Neck Squamous Cell Carcinomas. Turk Arch
Otorhinolaryngol 2015;53:120-7.
20. Grivennikov S, Karin E, Terzic J, et al. IL-6 and Stat3
are required for survival of intestinal epithelial cells and development of colitis-associated cancer. Cancer
Cell 2009;15:103-13.
21. Hussain SP, Harris CC. Inflammation and cancer:
an ancient link with novelpotentials. Int J Cancer
2007;121:2373-80. 22. Karin M. Nuclear factor-kappa B in cancer development
and progression. Nature 2006;41:431-6.
23. Okada F. Beyond foreign-body-induced carcinogenesis:impact of reactive oxyge
species derived from inflammatory cells in tumorigenic conversion and Tumor progression. Int J
Cancer 2007;121:2364-72.
24. Chan AT, Ogino S, Fuchs CS. Aspirin and the risk of
colorectal cancer in relation to the expression of COX-
2. N Engl J Med 2007;356:2131-42.
25. Wang W, Bergh A, Damber JE. Morphological transition
of proliferative inflammatory atrophy to high-grade
intraepithelial neoplasia and cancer in human
prostate. Prostate 2009;69:1378-86.
26. Ergin G, Kopru B, Kirac M, et al. Predictive Significance
of Preoperative Neutrophil to Lymphocyte Ratio versus
Platelet to Lymphocyte Ratio for Gleason Score in
Prostate Cancer Patients. Erciyes Med J 2018;40:228-
33.
27. Langsenlehner T, Thurner EM, Krenn-Pilko S, et al.
Validation of the neutrophil-to-lymphocyte ratio as
a prognostic factor in a cohort of European prostate
cancer patients. World J Urol 2015;33:1661-7.
28. Lee H, Jeong SJ, Hong SK, et al. High preoperative
neutrophil-lymphocyte ratio predicts biochemical
recurrence in patients with localized prostate cancer
after radical prostatectomy. World J Urol 2016;34:821-
7.
29. Ipekci T, Yuksel M, Ucar M, et al. Preoperative
Neutrophil Lymphocyte Ratio a Reliable Prognostic
Parameter for Localized Prostate Cancer? Bull
Urooncol 2017;16:119-22.
30. Zanaty M, Ajib K, Alnazari M, et al. Prognostic
utility of neutrophil-to-lymphocyte and platelets-
to-lymphocyte ratio in predicting biochemical
recurrence post robotic prostatectomy. Biomark Med
2018;12:841-8.