Neutrophil–lymphocyte ratio prior to steroids as a prognostic marker in men with metastatic castration-resistant prostate cancer

Introduction

The neutrophil–lymphocyte ratio (NLR) is prognostic in a number of tumour types, with conflicting results in metastatic castration-resistant prostate cancer (mCRPC). The aim of this study was to assess whether the NLR prior to the administration of premedication steroids is a prognostic marker in men with mCRPC treated with taxane-based chemotherapy.

Patients and methods

This was a retrospective study of men with mCRPC receiving taxane-based chemotherapy between 2005 and 2012. Patients were included if laboratory results were available between two and 28 days prior to the commencement of chemotherapy. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards regression models were used to determine the prognostic significance of NLR on OS and PFS.

Results

OS was significantly better in patients with NLR <5 (n=28) compared to those with NLR >5 (n=14), with median OS 32 months vs 14.9 months respectively (HR 2.15, 95% CI 1.07–4.33, p=0.0003). PFS was 10 months in those with NLR <5 vs 5 months in those with NLR >5 (HR 2, 95% CI 0.99–3.66, p=0.01). Multivariate analysis confirmed NLR (p=0.004) to be an independent prognostic factor for OS.

Conclusion

The findings from this study support the use of baseline NLR as a prognostic biomarker in men with mCRPC receiving taxane based chemotherapy. An elevated NLR (>5) is associated with a shorter survival in this group of patients.