Prognostic significance of elevated pretreatment systemic inflammatory markers for patients with prostate cancer: a meta-analysis

Hao Peng,Xiaogang Luo

doi:10.1186/s12935-019-0785-2

Abstract

BackgroundPretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa). However, the prognostic effects remain controversial. Therefore, the goal of this study was evaluate the prognostic values of these markers for PCa patients using a meta-analysis.MethodsPotentially relevant publications in PubMed and Cochrane Library were searched. Pooled hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), recurrence free survival (RFS) and distant metastases-free survival (DMFS) were determined using a fixed or random effects model by STATA 13.0 software.ResultsThirty-two studies involving 21,949 participants were included. Our pooled results demonstrated that a high pretreatment NLR (HR = 1.55, 95% CI 1.37–1.76), PLR (HR = 1.72; 95% CI 1.36–2.18), neutrophil (HR = 1.10; 95% CI 1.03–1.18 and monocyte counts (HR = 2.25; 95% CI 1.67–3.05) predicted inferior OS, while elevated pretreatment LMR (HR = 2.27; 95% CI 1.76–2.94) was correlated with favorable OS. Furthermore, the higher NLR (HR = 1.62; 95% CI 1.29–2.04) and monocyte counts (HR = 1.75; 95% CI 1.36–2.25), but lower LMR predicted worse PFS (HR = 2.18; 95% CI 1.58–3.02); poor RFS was only associated with NLR (HR = 1.12; 95% CI 1.04–1.20). The subgroup analysis showed that the higher NLR may be a predictive factor for OS only in patients with mCRPC and undergoing chemotherapy; while the higher PLR was only significantly associated with OS in localized PCa regardless of treatment.ConclusionThis meta-analysis reveals that pretreatment NLR, PLR, LMR, neutrophil, and monocyte counts may be effective predictive biomarkers for prognosis in patients with PCa.

Highlights

Pretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa)
The results showed that elevated NLR predicted poor prognosis in almost all of stratified categories except localized PCa (HR = 1.10; 95% confidence interval (CI) 0.93–1.31, P = 0.274), surgery (HR = 1.12; 95% CI 0.99–1.26, P = 0.072), radiotherapy (HR = 1.10; 95% CI 0.95–1.27, P = 0.198) for overall survival (OS); and surgery (HR = 1.64; 95% CI 0.51–5.26, P = 0.404), prospective study design for progression-free survival (PFS) (HR = 1.42; 95% CI 0.89– 2.26, P = 0.144) (Table 4)
The results indicated that a high pretreatment NLR, PLR, neutrophil and monocyte counts predicted inferior OS outcomes; while elevated pretreatment LMR was correlated with favorable OS

Summary

Introduction

Pretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa). The goal of this study was evaluate the prognostic values of these markers for PCa patients using a meta-analysis. Androgen deprivation therapy, radiotherapy and chemotherapy have been recommended for treatment of patients with PCa, the overall survival (OS) rate remains unsatisfactory (5-year: 77.52%; 10-year: 62.57%) due to tumor local recurrence, progression or distal metastasis [2]. Prognosis of patients with PCa can be predicted by pathologic tumor, node, metastasis (TNM) staging, prostate-specific antigen (PSA) level [3], PSA doubling time [3] and Gleason score [4]. Supplementary pretreatment biomarkers should be developed to assist clinicians to evaluate prognosis and further guide decision-making concerning therapeutic strategies

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