Change of the Neutrophil-to-Lymphocyte Ratio during Treatment: A Potential Prognostic Biomarker in Metastatic Prostate Cancer Treated with Radium-223 Dichloride

Abstract

The neutrophil to lymphocyte ratio (NLR) at baseline has been shown to have prognostic value in metastatic prostate cancer. Little is known about the importance of a change in the NLR during treatment in patients treated with Radium-223 (223Ra). We investigated the prognostic value of the NLR at baseline and during therapy in patients with metastatic prostate cancer treated with 223Ra and also in patients treated with Docetaxel. We reviewed all patients treated with 223Ra in our center and randomly chosen patients treated with Docetaxel. Patients were stratified according to NLR ≤ 5 and >5 at baseline and at 12 weeks of therapy. The relationship between NLR measured at baseline and at 12 weeks and overall survival (OS) were evaluated. A total of 149 patients treated with 223Ra and 170 with Docetaxel were evaluated. For patients treated with 223Ra, overall survival was significantly better in patients that had both an NLR ≤ 5 at baseline and at 12 weeks. No such effect of NLR was found in patients treated with Docetaxel. In the present study, NLR at baseline and after 12 weeks of therapy was found to be prognostic factor in patients treated with 223Ra but not in those treated with Docetaxel.

Prognostic value of neutrophil‐to‐lymphocyte ratio in patients with metastatic castration‐resistant prostate cancer receiving prostate‐specific membrane antigen targeted radionuclide therapy

“…43 In another series analyzing men undergoing treatment with Ra-223 dichloride, OS was significantly longer in individuals that had both an NLR ≤ 5, compared to those treated with docetaxel chemotherapy. 13 Ra-223 dichloride may have a direct effect on the bone marrow due to proximity which may be reflected by the lymphocytes and neutrophil count, which may modulate the host's immune response to cancer through treatment.…”

“…The NLR is thought to reflect systemic inflammation as well as the host immune response and the tumor microenvironment 10,11 . Independently, the lymphocyte and neutrophil counts depend on many factors and can be influenced by systemic therapy 12–14 . Emerging evidence indicates that a high NLR is associated with a lower PSA response rate after treatment for mCRPC using chemotherapy and androgen synthesis inhibitors.…”

“…10,11 Independently, the lymphocyte and neutrophil counts depend on many factors and can be influenced by systemic therapy. [12][13][14] Emerging evidence indicates that a high NLR is associated with a lower PSA response rate after treatment for mCRPC using chemotherapy and androgen synthesis inhibitors. Also, poorer progression-free survival and OS were reported for men with mCRPC who had a high NLR.…”

The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review

“…suggesting the need for further study. [146][147][148][149] Investigating specifically SII in a retrospective multicentre cohort of over 6000 men treated surgically for localised PCa, elevated presurgical SII was found to be significantly associated with both adverse surgical pathology and longer term BCR. 150 The predictive value of the SII is supported by other studies in localised PCa post surgery examining not only BCR but also long term survival.…”

“…A retrospective study from Japan on 633 men before PCa diagnosis found, by contrast, low NLR and PLR were predictive of finding PCa at subsequent biopsy 145 . In other studies, the accuracy of NLR as a prognostic marker of disease progression in localised PCa or response to treatment (e.g., docetaxel, cabazitaxel or radium‐223) in advanced PCa has been inconclusive suggesting the need for further study 146–149 …”