Sonpavde Guru, Pond Gregory R, Armstrong Andrew J, Clarke Stephen J, Vardy Janette L, Templeton Arnoud J, Wang Shaw-Ling, Paolini Jolanda, Chen Isan, Chow-Maneval Edna, Lechuga Mariajose, Smith Matthew R, Michaelson M Dror
University of Alabama, Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL.
Ontario Clinical Oncology Group, McMaster University, Hamilton, Canada.
Clin Genitourin Cancer. 2014 Oct;12(5):317-24. doi: 10.1016/j.clgc.2014.03.005. Epub 2014 Mar 15.
We retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with progressive metastatic castration resistant prostate cancer (mCRPC) following docetaxel.
The SUN-1120 phase III trial comparing prednisone combined with sunitinib (n = 584) or placebo (n = 289) for mCRPC following docetaxel-based chemotherapy was evaluated. The arms were combined for analysis, since no difference was observed in the primary endpoint of overall survival (OS). A logarithmic transformation was applied to non-normal factors. The Kaplan-Meier method was used for OS estimation. To identify an optimal prognostic model for survival, we used a Cox proportional hazards regression method with forward stepwise selection, stratifying for ECOG PS, progression type (prostate specific antigen [PSA] or radiographic) and treatment group. Patients were categorized into risk groups.
Complete data was evaluable for 784 men. The factors used in the model that remained individually significant for OS in multivariable analysis were: log-lactate dehydrogenase level (LDH) level (HR 2.86 [95% CI = 2.29, 3.56], P < .001), hemoglobin (0.80 [0.74, 0.85], P < .001), > 1 organ involved by metastatic disease (1.49 [1.21, 1.84], P < .001), log-alkaline phosphatase (1.13 [0.99, 1.28], P = .074), log-number of prior cycles of docetaxel (0.84 [0.71, 0.98], P = .031), progression on docetaxel (1.35 [1.00, 1.81], P = .049), log-PSA (1.06 [1.00, 1.12], P = .075) and log-NLR (1.55 [1.32, 1.83], P < .001). NLR increased the c-statistic of the prognostic model from 0.703 to 0.715.
High NLR may be associated with an independent poor prognostic impact in post-docetaxel patients with mCRPC. These data warrant external validation.
我们回顾性评估了中性粒细胞与淋巴细胞比值（NLR）作为多西他赛后进展性转移性去势抵抗性前列腺癌（mCRPC）男性患者炎症和免疫状态标志物的预后影响。
对SUN - 1120 III期试验进行评估，该试验比较了泼尼松联合舒尼替尼（n = 584）或安慰剂（n = 289）用于多西他赛化疗后的mCRPC。由于在总生存期（OS）的主要终点未观察到差异，因此将两组合并进行分析。对非正态因素进行对数转换。采用Kaplan - Meier方法估计OS。为了确定生存的最佳预后模型，我们使用Cox比例风险回归方法并进行向前逐步选择，按东部肿瘤协作组（ECOG）体能状态、进展类型（前列腺特异性抗原[PSA]或影像学）和治疗组进行分层。将患者分为风险组。
784名男性的完整数据可评估。在多变量分析中对OS仍具有个体显著意义的模型中使用的因素包括：对数乳酸脱氢酶（LDH）水平（HR 2.86 [95% CI = 2.29, 3.56]，P <.001）、血红蛋白（0.80 [0.74, 0.85]，P <.001）、有>1个器官发生转移疾病（1.49 [1.21, 1.84]，P <.001）、对数碱性磷酸酶（1.13 [0.99, 1.28]，P =.074）、多西他赛既往疗程数的对数（0.84 [0.71, 0.98]，P =.031）、多西他赛治疗期间进展（1.35 [1.00, 1.81]，P =.049）、对数PSA（1.06 [1.00, 1.12]，P =.075）和对数NLR（1.55 [1.32, 1.83]，P <.001）。NLR将预后模型的c统计量从0.703提高到0.715。
高NLR可能与多西他赛后mCRPC患者独立的不良预后影响相关。这些数据有待外部验证。
