Centre Hospitalier Universitaire Nantes, Nantes, France.
Oncology Division, Department of Surgery, Faculty of Medicine, Centre Hospitalier Universitaire (CHU) de Québec Research Centre, Université Laval, Québec, QC, Canada.
Eur Urol Oncol. 2020 Jun;3(3):298-305. doi: 10.1016/j.euo.2019.01.009. Epub 2019 Jan 31.
The neutrophil-lymphocyte ratio (NLR) is an inexpensive and accessible prognostic marker for many cancers, including metastatic castration-resistant prostate cancer (mCRPC).
In this study, we assess the role of NLR as a predictive biomarker through a retrospective analysis of the pivotal COU302 study of abiraterone acetate (AA) as first-line therapy for men with asymptomatic or minimally symptomatic mCRPC.
DESIGN, SETTING, AND PARTICIPANTS: The COU302 study randomized asymptomatic or minimally symptomatic men with mCRPC to receive AA plus prednisone or prednisone as first-line treatment. Baseline NLR, overall survival, radiographic progression-free survival, and prostate-specific antigen (PSA) progression-free survival were evaluated.
Descriptive statistics, as well as Kaplan-Meier and Cox survival models were used to assess the effect of baseline NLR and changes in NLR on response to AA plus prednisone versus prednisone, with adjustment for important covariates.
Among the 1082 patients who received treatment, baseline NLR values showed no significant differences according to baseline covariates except for albumin. Baseline variables were similar between dichotomous groups with an NLR cutoff of 2.5, except for a lower proportion of patients with >10 bone metastases in the NLR <2.5 group. Our survival results demonstrate that higher NLR values corresponded to poorer overall survival and PSA response to AA but not to placebo, which was confirmed in our adjusted regression models. No significant differences were seen in time to radiographic progression. In separate analyses, an increase or decrease in NLR by 2 from treatment baseline did not clearly signal subsequent lack of benefit with continued AA.
Our results suggest that baseline NLR may be able to predict response to AA in men with asymptomatic mCRPC but that changes in NLR during treatment are insufficient to guide treatment. Further validation studies are warranted.
In this report, we look at the ratio of circulating immune cells as a predictor of response to abiraterone acetate (AA), using data from a large trial. Our results suggest that this ratio derived from routinely obtained bloodwork can predict which patients respond better to AA.
中性粒细胞与淋巴细胞比值（NLR）是许多癌症包括转移性去势抵抗性前列腺癌（mCRPC）的一种廉价且易于获取的预后标志物。
在这项研究中，我们通过回顾性分析醋酸阿比特龙（AA）作为无症状或轻度症状 mCRPC 男性一线治疗的 COU302 研究，评估 NLR 作为预测生物标志物的作用。
设计、地点和参与者：COU302 研究将无症状或轻度症状的 mCRPC 男性随机分配接受 AA 加泼尼松或泼尼松作为一线治疗。评估了基线 NLR、总生存期、影像学无进展生存期和前列腺特异性抗原（PSA）无进展生存期。
使用描述性统计、Kaplan-Meier 和 Cox 生存模型评估基线 NLR 和 NLR 变化对 AA 加泼尼松与泼尼松反应的影响，并对重要协变量进行调整。
在接受治疗的 1082 名患者中，除白蛋白外，基线 NLR 值根据基线协变量没有显著差异。除 NLR<2.5 组中>10 处骨转移患者比例较低外，二分类组的基线变量相似。我们的生存结果表明，较高的 NLR 值与 AA 治疗后的总生存期和 PSA 反应较差相关，但与安慰剂无关，这在我们的调整回归模型中得到了证实。在影像学进展方面没有明显差异。在单独的分析中，NLR 从治疗基线增加或减少 2 并不清楚表明继续使用 AA 缺乏后续获益。
我们的结果表明，基线 NLR 可能能够预测无症状 mCRPC 男性对 AA 的反应，但治疗期间 NLR 的变化不足以指导治疗。需要进一步的验证研究。
在本报告中，我们使用一项大型试验的数据，研究循环免疫细胞的比值作为预测对阿比特龙（AA）反应的指标。我们的研究结果表明，这种比值可以预测哪些患者对 AA 反应更好。
