Pretreatment neutrophil-to-lymphocyte ratio as a potential prognostic biomarker for newly diagnosed patients with metastatic castration-sensitive prostate cancer

Background Although the prognostic role of neutrophil-to-lymphocyte ratio (NLR) has been assessed in patients with metastatic castration-resistant prostate cancer, data on its impact on oncological outcomes of patients with metastatic castration-sensitive prostate cancer (mCSPC) are scarce. Aim This study aims to examine the influence of elevated pretreatment NLR on time to prostatic-specific antigen (PSA) progression and overall survival (OS) of patients with mCSPC. Methods We retrospectively reviewed patients presenting between June 2007 and June 2019 with mCSPC. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. Multivariate analyses were used to assess the factors influencing time to PSA progression and OS. Results A total of 189 patients were included; median age = 69 years, median PSA = 155 ng/mL, 41(22%) had visceral metastasis. Median time to PSA progression was shorter for patients with NLR >= 4 (n = 37) compared to patients with NLR < 4 (n = 146); 11.3 and 18.3 months, respectively, P = .015. Patients with NLR >= 4 also had inferior median OS (23.9 vs 49.5 months, P = .001). On multivariate analysis, NLR >= 4 was not an independent factor for time to PSA progression. However, NLR >= 4 was an independent factor of inferior OS (HR: 2.75, 95% CI: 1.01-7.87, P = .047). Other independent factors predicting inferior OS included Eastern Cooperative Oncology Group Performance Status >= 1, high-volume status, and Hb < 12. Conclusion Elevated pretreatment NLR independently predicts inferior OS in newly diagnosed patients with mCSPC. However, NLR was not a predictor of time to PSA progression.