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Neutrophil-to-lymphocyte ratio improved accuracy of prognostic score for castration-resistant prostate cancer
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A prognostic score that included neutrophil-to-lymphocyte ratio accurately predicted OS for men with metastatic castration-resistant prostate cancer, according to study results.
Arnoud J. Templeton, MD, of the division of medical oncology and hematology at Princess Margaret Cancer Centre of the University of Toronto, and colleagues evaluated neutrophil-to-lymphocyte ratio and other established prognostic variables in 357 chemotherapy-naive patients in the training cohort.
The median age of patients was 71 years, and 12% had liver metastases. All patients in the training cohort received docetaxel every 3 weeks.
Median OS of the training cohort was 14.7 months.
Results of a multivariate analysis indicated liver metastases, hemoglobin ˂12 g/dL, alkaline phosphatase greater than two times the upper limit of normal, lactate dehydrogenase >1.2 times the upper limit of normal, and a neutrophil-to-lymphocyte ratio >3 at baseline were significantly associated with shorter OS.
Templeton and colleagues then developed a prognostic score that utilized these risk factors. They assigned one risk point for each significant variable, then established four risk categories: 0 points, 1 point, 2 points, and 3 to 5 points.
Two-year OS rates were highest among patients with 0 risk variables (43%) and 1 risk variable (37%). Researchers calculated 2-year OS rates of 12% among patients with two risk variables and 3% for patients with three to five risk variables.
Templeton and colleagues then evaluated the prognostic score in a 215-patient validation cohort. They reported good separation of survival curves and “fairly good discriminatory accuracy.”
The area under the curve for the training cohort was 0.78 (95% CI, 0.72-0.84), whereas the area under the curve for the validation cohort was 0.66 (95% CI, 0.58-0.74).
“We demonstrated the improved prognostic information obtained by adding the neutrophil-to-lymphocyte ratio to known and clinical laboratory prognostic factors,” Templeton and colleagues concluded. “The neutrophil-to-lymphocyte ratio is a promising, readily available and inexpensive biomarker that adds prognostic information to current risk scores.”
Assessment of systemic inflammation with the neutrophil-to-lymphocyte ratio may provide a surrogate biomarker in this setting moving forward, David J. Pinato, MD, MRes, MRCP, PhD, wrote in an accompanying editorial.
“The model presented by Templeton et al provides clinicians with an improved tool to help prioritize active treatment over best supportive care according to expected survival outcomes, making treatment decisions more objective and evidenced based in an era of spiraling costs of anticancer drugs,” Pinato wrote. “In addition to representing a refined and easy-to-compute model to identify the various disease phenotypes encompassed within the broad definition of castration-resistant prostate cancer, these data provide clinicians and scientists with the invigorating challenge of extending the utility of systemic inflammation from a prognostic tool to a source of surrogate biomarkers and therapeutic targets to further promote individualized management of patients with castration-resistant prostate cancer.”
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Disclosure: The study was funded in part by the Swiss Cancer Research Foundation. Pinato reports no relevant financial disclosures.