Ferro Matteo, Musi Gennaro, Serino Alessandro, Cozzi Gabriele, Mistretta Francesco Alessandro, Costa Beatrice, Bianchi Roberto, Cordima Giovanni, Luzzago Stefano, Di Trapani Ettore, Tagliabue Elena, Vartolomei Mihai Dorin, Terracciano Daniela, Cassatella Maria C, Salvatici Michela, Conti Andrea, Sandri Maria Teresa, Cioffi Antonio, Turetti Matteo, Catellani Michele, Bottero Danilo, Matei Deliu Victor, Mirone Vincenzo, de Cobelli Ottavio
Division of Urology, European Institute of Oncology, Milan, Italy,
Division of Urology, European Institute of Oncology, Milan, Italy.
Urol Int. 2019;102(1):43-50. doi: 10.1159/000494259. Epub 2018 Nov 8.
Several biochemical and clinical markers have been proposed for selecting patients for active surveillance (AS). However, some of these are expensive and not easily accessible. Moreover, currently about 30% of patients on AS harbor aggressive disease. Hence, there is an urgent need for other tools to accurately identify patients with low-risk prostate cancer (PCa).
We retrospectively reviewed the medical records of 260 patients who underwent radical prostatectomy and were eligible for AS according to the following criteria: clinical stage T2a or less, prostate-specific antigen level < 10 ng/mL, 2 or fewer cores involved with cancer, Gleason score (GS) ≤6 grade, and prostate-specific antigen density < 0.2 ng/mL/cc.
Univariate and multivariate analyses were performed to evaluate the association of patient and tumor characteristics with reclassification, defined as upstaged (pathological stage >pT2) and upgraded (GS ≥7) disease. A base model (age, prostate-specific antigen, prostate volume, and clinical stage) was compared with models considering neutrophil to lymphocyte ratio (NLR) or platelets to lymphocyte ratio (PLR), monocyte to lymphocyte (MLR), and eosinophil to lymphocyte ratio (ELR). OR and 95% CI were calculated. Finally, a decision curve analysis was performed.
Univariate and multivariate analyses showed that NLR, PLR, and ELR upgrading were significantly associated with upgrading (ORs ranging from 2.13 to 4.13), but not with upstaging except for MLR in multivariate analysis, showing a protective effect.
Our results showed that NLR, PLR, and ELR are predictors of Gleason upgrading. Therefore, these inexpensive and easily available tests might be useful in the assessment of low-risk PCa, when considering patients for AS.
已经提出了几种生化和临床标志物用于选择进行主动监测（AS）的患者。然而，其中一些标志物价格昂贵且不易获得。此外，目前约30%接受主动监测的患者患有侵袭性疾病。因此，迫切需要其他工具来准确识别低风险前列腺癌（PCa）患者。
我们回顾性分析了260例行根治性前列腺切除术且符合以下标准的患者的病历：临床分期为T2a或更低、前列腺特异性抗原水平<10 ng/mL、癌灶累及2个或更少的核心组织、Gleason评分（GS）≤6级以及前列腺特异性抗原密度<0.2 ng/mL/cc。
进行单因素和多因素分析，以评估患者和肿瘤特征与重新分类的相关性，重新分类定义为分期上调（病理分期>pT2）和分级上调（GS≥7）疾病。将基础模型（年龄、前列腺特异性抗原、前列腺体积和临床分期）与考虑中性粒细胞与淋巴细胞比值（NLR）或血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）以及嗜酸性粒细胞与淋巴细胞比值（ELR）的模型进行比较。计算比值比（OR）和95%置信区间（CI）。最后，进行决策曲线分析。
单因素和多因素分析表明，NLR、PLR和ELR分级上调与分级上调显著相关（OR值范围为2.13至4.13），但除多因素分析中的MLR外，与分期上调无关，显示出保护作用。
我们的结果表明，NLR、PLR和ELR是Gleason分级上调的预测指标。因此，在考虑对患者进行主动监测时，这些廉价且易于获得的检测方法可能有助于评估低风险PCa。
