Baseline Neutrophil-Lymphocyte Ratio (NLR) is Associated with Survival and Response to Treatment with Second-Line Chemotherapy for Advanced Prostate Cancer Independent of Baseline Steroid Use
Menée à partir de données portant sur 755, 654 et 405 patients atteints d'un cancer métastatique de la prostate résistant à la castration et recevant une chimiothérapie de seconde ligne, cette étude met en évidence une association entre le rapport neutrophiles/lymphocytes et la réponse au traitement ou la survie globale des patients, cela indépendamment de l'utilisation de stéroïdes
Background : The neutrophil-lymphocyte ratio (NLR), proposed as an indicator of cancer-related inflammation, has known prognostic value in prostate cancer. We examine its association with survival (OS) and response in patients treated with second-line chemotherapy.
Methods : We analyzed patients with metastatic castration-resistant prostate cancer (mCRPC) treated in the TROPIC trial, evaluating cabazitaxel versus mitoxantrone. Cox-regression models were used to investigate the association of baseline NLR (BLNLR) with OS and the significance of a change in NLR count with treatment. Logistic regression models were used to determine the association of baseline NLR counts with PSA and RECIST responses. The optimal NLR cut-off was established based on the concordance index of different values.
Results : Data from 755, 654 and 405 patients was available for OS, PSA and RECIST response analysis respectively. Median OS was 14.0 months (95%CI 13.2–14.8). Median NLR was 2.9 (IQR:1.9–5.1). BLNLR was associated with survival (HR 1.5, 95%CI 1.1-2.1, p=0.011) in multivariable analysis (MVA) independently of variables included in the Halabi nomogram, treatment arm and corticosteroid use. The optimal cut-off for a dichotomous NLR was selected at 3.0 based on its higher c-index related to survival. BLNLR ≥3.0 was associated with lower PSA response (40.1% vs 59.9%; p<0.001) and RECIST response (7.7% vs 15.6%, p=0.022) in MVA. Conversion from high (≥3) to low (< 3) NLR was associated with improved survival (HR 0.66; 95% CI 0.51 – 0.85; p=0.001) and higher PSA response rates (66.4% vs 33.6%; p=0.000). Use of corticosteroids at baseline did not modify the association between NLR and survival.
Conclusions : NLR is a valid prognostic biomarker in CRPC and is associated with survival, PSA and RECIST responses in patients treated with second-line chemotherapy. Changes in NLR counts with treatment may indicate benefit. NLR prognostic value is independent of prior use of corticosteroids.
Annals of Oncology , résumé, 2014