Prognostic Value Of Neutrophil-to-lymphocyte Ratio And Establishment Of Novelpre-therapy Risk Stratification Model In Prostate Cancer

OBJECTIVE : Preoperative prognostic factors in prostate cancer patients have not been fully evaluated.This study was undertaken to investigate preoperative prognostic factors,including pre-treatment neutrophil-to-lymphocyte ratio(NLR),and to develop a novel prognostic factors– based risk stratification model for progression-free survival(PFS)in prostate cancer patients.METHODS : We performed a retrospective analysis of 104 consecutive prostate cancer patients that treated at our institution.Prognostic value of the pre-therapy clinical and laboratory parameters were evaluated by univariate and multivariate Cox proportional hazard model analyses,and patients were stratified according to Prognostic Indexs(PIs)for PFS.Using the Medcalc to analyzed the areas under the Operating Characteristic Curve(AUOCC)compared new stratification based on NLR with NCCN clinic risk stage in order to test the distinctivenesses of PFS and these parameters.RESULTS : According to the relationship between NLR value and prognosis,we determined the cut-off value of NLR was 1.99(AUROC=0.583,Se 69%,Sq 50.7%).1)The NLR was statistically significant with patient’s pre-therapy PSA value,pre-therapy ALP value,clinical risk group,respectively.2)All cases’ 1,3,5-year cumulative progression free survival rates were84%,59%,55%.In univariate analysis,pre-therapy NLR,pre-therapy ALP value,tumor stage,axial skeleton bone scan,clinic lymphonodus assessment,treatment method were significantly associated with PFS(p<0.05).3)In multivariate analysis,pre-therapy NLR,tumor stage,axial skeleton bone scan were independent factors for predicting poor prognosis.Prognosis Index equation was : [h(t)=h0exp(1.02×NLR+1.144×axial skeleton bone scan,+1.472×tumor stage),χ2 =28.03,p<0.0001].ROC curve analysis:the area under the curve of0.802(95%CI 0.693-0.91),The best cutoff value is 2.555(sensitivity65.5%,specificity 85.3%).4)Patients were stratified into 3 risk groups: low(n=52,PI<1.815),intermediate(n =34,1.815≤PI<3.64),and high(n=18,PI>3.64).The 1,2,3-year progression free survival rates of new low risk group were95.0%,85.7%,80.7%。The 1,2,3-year progression free survival rates of new intermediate risk group were 93.2%,81.4%,62.2%。The 1,2,3-year progression free survival rates of new high risk group were 47.4%,20.3%,0%。There was not statistically significant of progression free survival rates between low risk group and intermediate risk group(χ2=2.032,p=0.154).The progression free survival rates between low risk group and intermediate risk group was statistically significant(χ2=45.792,p=0.000).The progression free survival rates between intermediate risk group and high risk group was statistically significant(χ2=29.517,p=0.000)。CONCLUSIONS:NLR was an independent prognostic factor,as were axial skeleton bone scan and tumor stage,and the combination of these factors can stratify PFS risks in prostate cancer patients.This viewpoint may be useful fordiscerning patients who might be candidates for clinical trials of multimodal treatment strategies,may be a supplement to the NCCN risk group classification.