Cao Jian, Zhu Xuan, Zhao Xiaokun, Li Xue-Feng, Xu Ran
Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China.
MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, United Kingdom.
PLoS One. 2016 Jul 1;11(7):e0158770. doi: 10.1371/journal.pone.0158770. eCollection 2016.
An unprecedented advance has been seen in castration-resistant prostate cancer (CRPC) treatments in the past few years. With a number of novel agents were approved, there is a pressing need to develop improved prognostic biomarkers to facilitate the personalised selection and sequencing of these novel agents. Emerging evidence indicates that the neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival in patients with prostate cancer (PCa). However, the importance of the NLR for the prediction of the PSA response (PSARS) and biochemical recurrence (BCR) has been largely neglected. Here, we conducted a systematic review and meta-analysis to evaluate the prognostic value of the NLR for the PSARS, BCR, and survival in PCa. A systematic database search was performed using Embase, PubMed, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI). A meta-analysis was performed by pooling hazard ratios (HRs), odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). A total of 22 studies were included in the meta-analysis. Our results suggest that an elevated NLR predicts a lower PSARS rate (OR = 1.69, 95% CI: 1.40-1.98) and a higher possibility of BCR (HR = 1.12, 95% CI: 1.02-1.21). Additionally, we confirmed that an elevated NLR was a prognostic predictor of shorter overall survival (OS) in both metastatic castration-resistant PCa (mCRPC) (HR = 1.45, 95% CI: 1.32-1.59) and localized PCa (LPC) (HR = 1.12, 95% CI: 1.01-1.23) and that it predicted worse progression-free survival (PFS) in CRPC (HR = 1.42, 95% CI: 1.23-1.61) and poorer recurrence-free survival (RFS) (HR = 1.38, 95%CI: 1.01-1.75) in LPC. Our results suggest that an elevated NLR might be employed as a prognostic marker of biochemical changes and prognosis to facilitate risk stratification and decision making for individual treatment of PCa patients. The potential mechanisms underlying these associations and future research directions are also discussed.
在过去几年中，去势抵抗性前列腺癌（CRPC）的治疗取得了前所未有的进展。随着多种新型药物获批，迫切需要开发更好的预后生物标志物，以促进这些新型药物的个性化选择和排序。新出现的证据表明，中性粒细胞与淋巴细胞比值（NLR）与前列腺癌（PCa）患者较差的生存率相关。然而，NLR对预测前列腺特异性抗原反应（PSARS）和生化复发（BCR）的重要性在很大程度上被忽视了。在此，我们进行了一项系统综述和荟萃分析，以评估NLR对PCa患者的PSARS、BCR和生存率的预后价值。使用Embase、PubMed、Cochrane图书馆和中国知网（CNKI）进行了系统的数据库检索。通过汇总风险比（HRs）、比值比（ORs）和相应的95%置信区间（CIs）进行荟萃分析。共有22项研究纳入荟萃分析。我们的结果表明，NLR升高预示着较低的PSARS率（OR = 1.69，95%CI：1.40 - 1.98）和较高的BCR可能性（HR = 1.12，95%CI：1.02 - 1.21）。此外，我们证实，NLR升高是转移性去势抵抗性PCa（mCRPC）（HR = 1.45，95%CI：1.32 - 1.59）和局限性PCa（LPC）（HR = 1.12，95%CI：1.01 - 1.23）患者总生存期（OS）较短的预后预测指标，并且它预示着CRPC患者无进展生存期（PFS）较差（HR = 1.42，95%CI：1.23 - 1.61）以及LPC患者无复发生存期（RFS）较差（HR = 1.38，95%CI：1.01 - 1.75）。我们的结果表明，NLR升高可作为生化变化和预后的预后标志物，以促进PCa患者个体治疗的风险分层和决策制定。还讨论了这些关联背后的潜在机制和未来的研究方向。
