Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Urology, Asahi General Hospital, Asahi, Japan.
Prostate. 2020 May;80(7):559-569. doi: 10.1002/pros.23969. Epub 2020 Mar 5.
The inflammatory process has been reported to be involved in the formation and progression of various types of cancer. Recently, a peripheral inflammatory index, combining the derived neutrophils/(leukocytes minus neutrophils) ratio (dNLR) and the lactate dehydrogenase (LDH) level, was proposed as a useful prognostic marker in advanced nonsmall cell lung cancer. The prognostic value of inflammatory markers in prostate cancer has not been established. We aimed to validate the prognostic significance of this peripheral inflammatory index in metastatic castration-resistant prostate cancer (mCRPC).
Clinical data of 196 mCRPC patients were retrospectively collected from multiple institutions. Clinical factors and inflammatory markers at the development of CRPC, including white blood cell count, absolute neutrophil count, dNLR, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, C-reactive protein (CRP), and LDH levels, were evaluated. The patients were classified into three groups based on the inflammatory index: Good (low dNLR and LDH), Intermediate (high dNLR or LDH), and Poor (high dNLR and LDH). Overall survival (OS) and cancer-specific survival after CRPC were analyzed using Cox proportional hazard models and Kaplan-Meier methods.
The median age and baseline prostate-specific antigen level were 75 years and 397.15 ng/mL, respectively. On multivariate analysis, dNLR (≥1.51; hazard ratio [HR] = 1.624; P = .0173), LDH (≥upper limit of normal; HR = 2.065; P = .0004), alkaline phosphatase (≥310 U/L; HR = 2.546; P < .0001), and positive N stage (HR = 1.621; P = .048) were associated with poor OS after CRPC, whereas other inflammatory markers including the NLR were not. The Good inflammatory index group showed significantly longer OS after CRPC compared to the Intermediate and Poor groups, with median survivals of 46.2, 28.9, and 16.6 months, respectively.
The novel inflammatory index combining dNLR and LDH was a useful prognostic parameter in patients with mCRPC. Our analysis suggested that dNLR emerged as a more valuable prognostic marker than NLR.
炎症过程已被报道参与各种类型癌症的形成和进展。最近，一种外周炎症指数，结合衍生的中性粒细胞/（白细胞减去中性粒细胞）比值（dNLR）和乳酸脱氢酶（LDH）水平，被提出作为晚期非小细胞肺癌的一种有用的预后标志物。炎症标志物在前列腺癌中的预后价值尚未确定。我们旨在验证该外周炎症指数在转移性去势抵抗性前列腺癌（mCRPC）中的预后意义。
回顾性地从多个机构收集了 196 例 mCRPC 患者的临床数据。评估了 CRPC 发展时的临床因素和炎症标志物，包括白细胞计数、绝对中性粒细胞计数、dNLR、中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、C 反应蛋白（CRP）和 LDH 水平。根据炎症指数将患者分为三组：良好（低 dNLR 和 LDH）、中等（高 dNLR 或 LDH）和差（高 dNLR 和 LDH）。使用 Cox 比例风险模型和 Kaplan-Meier 方法分析总生存期（OS）和 CRPC 后的癌症特异性生存期。
中位年龄和基线前列腺特异性抗原水平分别为 75 岁和 397.15ng/mL。多变量分析显示，dNLR（≥1.51；风险比[HR] = 1.624；P = .0173）、LDH（≥正常值上限；HR = 2.065；P = .0004）、碱性磷酸酶（≥310 U/L；HR = 2.546；P < .0001）和阳性 N 期（HR = 1.621；P = .048）与 CRPC 后的不良 OS 相关，而其他炎症标志物包括 NLR 则不然。与中差两组相比，良好炎症指数组 CRPC 后的 OS 明显更长，中位生存时间分别为 46.2、28.9 和 16.6 个月。
结合 dNLR 和 LDH 的新型炎症指数是 mCRPC 患者有用的预后参数。我们的分析表明，dNLR 比 NLR 更有价值的预后标志物。
