Adhyatma Kharisma Prasetya, Prapiska Fauriski F, Siregar Ginanda Putra, Warli Syah Mirsya
Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia.
Open Access Maced J Med Sci. 2019 May 20;7(10):1628-1630. doi: 10.3889/oamjms.2019.177. eCollection 2019 May 31.
Over the past decades, the study of the microenvironment of cancer has supported the hypothesis between inflammation and cancer. Previous studies have demonstrated a promising value of platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory response in prostate cancer.
To evaluate their pre-biopsy values of PLR and NLR in predicting prostate cancer.
This is a diagnostic study with retrospective design. We included all benign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostate biopsy in Adam Malik Hospital between August 2011 and August 2015. We used PSA value above 4 ng/dL as the threshold for the biopsy candidates. The relationship between pre-biopsy variables affecting the percentage of prostate cancer risk was evaluated, including age, prostate-specific antigen (PSA) level, and estimated prostate volume (EPV). The PLR and NLR were calculated from the ratio of related platelets or absolute neutrophil counts with their absolute lymphocyte counts. The values then analysed to evaluate their associations with the diagnosis of BPH and PCa.
Out of 298 patients included in this study, we defined two groups consist of 126 (42.3%) BPH and 172 PCa (57.7%) patients. Mean age for both groups are 66.36 ± 7.53 and 67.99 ± 7.48 years old (p = 0.64), respectively. There are statistically significant differences noted from both BPH and PCa groups in terms of PSA (19.28 ± 27.11 ng/dL vs 40.19 ± 49.39 ng/dL), EPV (49.39 ± 23.51 cc vs 58.10 ± 30.54 cc), PLR (160.27 ± 98.96 vs 169.55 ± 78.07), and NLR (3.57 ± 3.23 vs 4.22 ± 2.59) features of both BPH and PCa groups respectively (p < 0.05). A Receiver Operating Characteristics (ROC) analysis was performed for PLR and NLR in analysing their value in predicting prostate cancer. The Area Under the Curve (AUC) of PLR is 57.9% with a sensitivity of 56.4% and specificity of 55.6% in the cut-off point of 143 (p = 0.02). The NLR cut-off point of 3.08 gives 62.8% AUC with 64.5% sensitivity and 63.5% specificity. These AUCs were comparable with the AUC of PSA alone (68.5%). We performed logistic regression between PSA, PLR, and NLR with result in the exclusion of PLR if calculated conjunctively. Therefore, NLR has a promising performance in predicting PCa in patients with PSA above 4 ng/dL (OR = 3.2; 95%CI: 1.96-5.11). We found as many as 80 (63.5%) patients with benign biopsy results with negative NLR value in this study.
NLR has promising value in predicting prostate cancer. A further prospective study in validating its diagnostic value was needed.
在过去几十年中，癌症微环境的研究支持了炎症与癌症之间的假说。先前的研究表明，血小板与淋巴细胞比值（PLR）和中性粒细胞与淋巴细胞比值（NLR）作为前列腺癌全身炎症反应具有潜在价值。
评估PLR和NLR在前列腺穿刺活检前预测前列腺癌的价值。
这是一项采用回顾性设计的诊断性研究。纳入2011年8月至2015年8月在亚当·马利克医院接受前列腺穿刺活检的所有良性前列腺增生（BPH）和前列腺癌（PCa）患者。我们将血清前列腺特异抗原（PSA）值高于4 ng/dL作为穿刺活检候选者的阈值。评估影响前列腺癌风险百分比的穿刺活检前变量之间的关系，包括年龄、前列腺特异抗原（PSA）水平和估计前列腺体积（EPV）。PLR和NLR通过相关血小板或绝对中性粒细胞计数与绝对淋巴细胞计数的比值计算得出。然后分析这些值以评估它们与BPH和PCa诊断的相关性。
本研究纳入的298例患者中，我们将其分为两组，分别为126例（42.3%）BPH患者和172例（57.7%）PCa患者。两组的平均年龄分别为66.36±7.53岁和67.99±7.48岁（p = 0.64）。BPH组和PCa组在PSA（19.28±27.11 ng/dL vs 40.19±49.39 ng/dL）、EPV（49.39±23.51 cc vs 58.10±30.54 cc）、PLR（160.27±98.96 vs 169.55± 78.07）和NLR（3.57±3.23 vs 4.22±2.59）特征方面均存在统计学显著差异（p < 0.05）。对PLR和NLR进行了受试者工作特征（ROC）分析，以分析它们在预测前列腺癌中的价值。PLR的曲线下面积（AUC）为57.9%，在临界值为143时，敏感性为56.4%，特异性为55.6%（p = 0.02）。NLR临界值为3.08时AUC为62.8%，敏感性为64.5%，特异性为63.5%。这些AUC与单独PSA的AUC（68.5%）相当。我们对PSA、PLR和NLR进行了逻辑回归分析，结果显示联合计算时PLR被排除。因此，NLR在预测PSA高于4 ng/dL的患者的PCa方面具有良好表现（OR = 3.2；95%CI：1.96 - 5. 11）。在本研究中，我们发现多达80例（63.5%）活检结果为良性的患者NLR值为阴性。
NLR在预测前列腺癌方面具有潜在价值。需要进一步进行前瞻性研究以验证其诊断价值。
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