Immunological markers as predictors of unfavorable pathomorphological characteristics, an upgrading, upstaging and risk group increase in prostate cancer patients after radical prostatectomy

Background. The role of systemic inflammation in carcinogenesis has been studied for a long time. Markers of systematic inflammation response, such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), are associated with the unfavorable course of many malignant neoplasms, including prostate cancer. However, the data on the role of immunological markers as predictors of aggressive forms of prostate cancer varies significantly.

Methods. In our center was performed a retrospective analysis of the treatment results of 74 patients, each of whom underwent laparoscopic radical prostatectomy for localized and locally advanced prostate cancer in 2022. 13 patients with insufficient data set were excluded from the analysis. Based on the preoperative complete blood count, the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were determined. Association of this markers with unfavorable pathomorphological characteristics of the tumor, upgrading, upstaging and risk group increase after radical treatment were determined.

Results. The medians of the values of NLR, PLR and LMR were 1.67, 113.8 and 343, respectively. This medians were used as a threshold value for dividing the sample into two groups. During the analysis, it was revealed that patients with an NLR value greater than 1.67 were more likely to have locally advanced prostate cancer (pT3 and higher) after pathomorphological examination than patients with an NLR value less than 1.67 (p=0.0241). The value of the immunological marker PLR exceeding 113.8 is associated with more frequent detection of high-grade prostate cancer (ISUP 4-5) (p=0.0416). At the same time, there was no statistically significant association between NLR, PLR, LMR and an upgrading, upstaging and risk group increase, positive surgical margin, and pelvic lymph node lesion (pN1) according to the results of postoperative pathomorphological examination (p>0.05).

Conclusions. Markers of systematic inflammation response, such as the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio, play a prognostic role in prostate cancer patients and are associated with a more aggressive course of the disease, specifically with presence of locally advanced disease, low differentiation of adenocarcinoma.

Dr. Sergey Reva is an oncologist and urologist specializing in urooncological disease research and outbreak response. He holds a PhD in Oncology from N.N.Petrov Research Institute of Oncology. The main scientific topic of work are prostate and bladder cancer. Professional affiliations: European association of urology, Société Internationale d'Urologie, American Urological Association. Sergey Reva has more than 20 publications in peer-reviewed journals (in English). He is currently chairman of the Urooncological Department, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia