NLR Ratio Predicts Nodal Involvement in Unfavorable, Non-Metastatic Prostate Cancer

A study published in Nature is the first to report on the value of preoperative neutrophil-to-lymphocyte (NLR) in predicting nodal involvement in the preprostatectomy setting for patients with unfavorable, clinically non-metastatic prostate cancer as well as overall survival in pN1 patients in the postprostatecomy setting.

The group of international researchers sought to determine the association of novel hematological markers with prostate cancer nodal involvement and evaluate their prognostic value in patients with pN1 disease. They designed a single-center retrospective study that included 205 patients treated with radical prostatectomy and lymphadenectomy between 2012 and 2018.

Logistic regression and Kaplan-Meier analyses were performed to evaluate the prognostic value of preoperative NLR in terms of nodal spread and survival, researchers noted.

Results of the analysis showed patients with pN1 disease presented with lower mean NLR (2.53 vs 3.86; P=.0025). Multivariable analysis of different hematological markers showed only NLR exceeding the median (≥2.7) predicted pN1 (odds ratio, 0.38; P=.0367) independently of biopsy grading and prostate-specific antigen (PSA).

Researchers also reported that in patients with pN1 disease, NLR ≥2.7 correlated with shorter overall survival (P=.0196), despite its association with reduced risk of pN1. High preprostatectomy NLR was negatively associated with pN1, yielding high negative predictive value in internal validation.

“We have validated internally NLR as a supplement to PSA and biopsy grading when predicting nodal status and evaluated the safety of implementing NLR in excluding nodal involvement,” study authors concluded. “With consecutive validation, NLR might be utilized in both pre- and postprostatectomy models.”