Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
World J Urol. 2019 Nov;37(11):2375-2384. doi: 10.1007/s00345-019-02658-1. Epub 2019 Feb 8.
To investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for the selection of the optimal sequencing strategy using docetaxel and androgen receptor axis-targeted (ARAT) agents in patients with M0 or M1 castration-resistant prostate cancer (CRPC). Currently, there is a need to identify biomarkers to guide optimal sequential treatment in CRPC.
This multicenter, retrospective analysis included 303 consecutive patients initially diagnosed with M0 or M1 CRPC between September 2009 and March 2017. Of these, 52 (17.2%) patients received pre-docetaxel ARAT agents and 189 (62.4%) patients received post-docetaxel ARAT agents. The prognostic ability of NLR at CRPC diagnosis regarding radiographic progression-free survival (rPFS) and cancer-specific survival (CSS) were investigated. For the analysis, the NLR level was dichotomized at 2.5, and evaluated according to sequencing strategy.
Multivariate analysis revealed NLR ≥ 2.5 as an independent predictor of a lower risk for CSS. During the median follow-up of 18.5 months, patients with NLR ≥ 2.5 exhibited significantly lower 1-year rPFS (p = 0.011) and 2-year CSS rates (p = 0.005) compared to patients with NLR < 2.5. Among patients with NLR < 2.5, the post-docetaxel ARAT agent sequencing group exhibited higher 1-year rPFS (p = 0.031) and 2-year CSS (p = 0.026) rates compared to the pre-docetaxel ARAT agent sequencing group. Among patients with NLR ≥ 2.5, rPFS and CSS rates were comparable regardless of ARAT agent sequencing.
NLR ≥ 2.5 at CRPC diagnosis is associated with a lower risk for CSS. Patients with NLR < 2.5 should primarily be offered docetaxel considering the survival benefit of docetaxel-to-ARAT agent sequencing.
探讨中性粒细胞与淋巴细胞比值（NLR）在 M0 或 M1 去势抵抗性前列腺癌（CRPC）患者中选择最佳序贯策略的预后价值，这些患者接受多西他赛和雄激素受体轴靶向（ARAT）药物治疗。目前，需要确定生物标志物来指导 CRPC 中的最佳序贯治疗。
这是一项多中心回顾性分析，纳入了 2009 年 9 月至 2017 年 3 月期间初诊为 M0 或 M1 CRPC 的 303 例连续患者。其中，52 例（17.2%）患者在接受多西他赛前接受了 ARAT 药物治疗，189 例（62.4%）患者在接受多西他赛后接受了 ARAT 药物治疗。研究了 NLR 在 CRPC 诊断时对放射性无进展生存期（rPFS）和癌症特异性生存期（CSS）的预后能力。为了分析，将 NLR 水平分为 2.5，并根据测序策略进行评估。
多变量分析显示，NLR≥2.5 是 CSS 风险较低的独立预测因素。在中位随访 18.5 个月期间，与 NLR<2.5 的患者相比，NLR≥2.5 的患者的 1 年 rPFS（p=0.011）和 2 年 CSS 率（p=0.005）显著降低。在 NLR<2.5 的患者中，与接受多西他赛前接受 ARAT 药物治疗的患者相比，接受多西他赛后接受 ARAT 药物治疗的患者的 1 年 rPFS（p=0.031）和 2 年 CSS（p=0.026）率更高。在 NLR≥2.5 的患者中，无论是否接受 ARAT 药物治疗，rPFS 和 CSS 率均无差异。
CRPC 诊断时 NLR≥2.5 与 CSS 风险较低相关。考虑到多西他赛至 ARAT 药物治疗的生存获益，NLR<2.5 的患者应首选多西他赛治疗。
