Neutrophil and Lymphocyte Counts as Clinical Markers for Stratifying Low-Risk Prostate Cancer

Introduction The neutrophil-to-lymphocyte ratio (NLR) has emerged as a ubiquitous prognostic biomarker in cancer-related inflammation, specifically in patients with metastatic castration-resistant prostate cancer (PCA). We evaluated the clinical utility of the preoperative NLR, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) as a risk stratification tool for patients with low-risk PCA. Materials and Methods We identified 217 low-risk PCA patients with preoperative hematologic data who had met the criteria for active surveillance but had undergone robot-assisted radical prostatectomy at our institution from 2006 to 2015. Logistic regression models were constructed to determine whether the baseline NLR, ANC, and ALC were associated with upstaging, upgrading, and biochemical recurrence (BCR). Survival analyses were performed using the Kaplan-Meier method. Results On multivariate analysis, a higher prostate-specific antigen level (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.148-2.104), a greater number of positive cores (OR, 2.098; 95% CI, 1.043-2.104), and a higher ALC (OR, 4.311; 95% CI, 1.258-14.770) were associated with upstaging. More importantly, the 5-year biochemical recurrence-free survival was significantly lower in the high ANC group (ANC > 4.0 × 10⁹/L) compared with that of the low ANC group (P =.011). The NLR was not associated with upstaging, upgrading, or BCR in our study cohort (P =.368, P =.573, and P =.504, respectively). The only significant association with upgrading was patient age (OR, 1.106; 95% CI, 1.043-1.173). Conclusion NLR was not useful in predicting adverse pathologic outcomes in our patients with low-risk PCA. However, relative neutrophilia and lymphocytosis might indicate an early manifestation of harboring a more aggressive PCA.