EAU 2018: Neutrophil to Lymphocyte Ratio is Associated with Lymph Node Invasion and Higher Nodal Burden in Contemporary High-Risk Patients
The authors evaluated 519 patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) for high risk PCa between 2011 and 2016 at a single tertiary care center. NLR was available in all cases and calculated from blood samples taken 1 week prior to RP. Univariable and multivariable (MVA) logistic regression analyses evaluated the impact of NLR on adverse pathological outcomes at RP (pT3b/pT4, LNI and Gleason score 8-10). Linear regression analyses examined the correlation of NLR and number of positive nodes in patients with LNI. The best-cut off methodology was employed to identify the best NLR value associated with the outcomes. The impact of NLR on the accuracy of the Briganti nomogram for LNI prediction was evaluated using the area under the curve (AUC) method. Kaplan-Meier curves and cox regression analyses tested the impact of NLR on biochemical recurrence (BCR).
The median NLR was 2.18. At RP, 382 (73.6%), 210 (40.5%) and 204 (39.3%) patients had pT3b/T4, Gleason score 8-10 and LNI, respectively. The mean number of nodes that were removed was 21. Median follow-up time was 60 months. The 5-year BCR-free survival rate was 46.0%. At MVA, higher NLR was associated with LNI (p=0.02). No association was observed when pT3b/pT4 disease or GS 8-10 were considered (all p≥0.6). At logistic regression analyses, increasing NLR was associated with a higher number of positive nodes in patients with LNI (beta=0.152, p=0.03). At best cut-off analyses, the NLR most significantly associated with LNI was 2.1 (p=0.001). When MVA predicting LNI were repeated with the identified cut-off, patients with NLR ≥2.1 had a 1.76-fold higher risk to harbor LNI compared to patients with lower NLR.
An elevated NLR was associated with LNI and higher lymph node burden in patients with high risk PCa. Moreover, NLR was associated with BCR after RP. These results support the integration of NLR in predictive models for LNI risk and cancer recurrence in high risk PCa.
Presented by: Bravi C.A. Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark