Simple prognostic score for metastatic castration-resistant prostate cancer with incorporation of neutrophil-to-lymphocyte ratio

Authors

  • Arnoud J. Templeton MD,

    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Carmel Pezaro MD,

    1. The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Sutton, Surrey, United Kingdom
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  • Aurelius Omlin MD,

    1. The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Sutton, Surrey, United Kingdom
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  • Mairéad G. McNamara MD, PhD,

    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Raya Leibowitz-Amit MD, PhD,

    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Francisco E. Vera-Badillo MD,

    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Gerhardt Attard MD, PhD,

    1. The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Sutton, Surrey, United Kingdom
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  • Johann S. de Bono MB ChB, PhD,

    1. The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Sutton, Surrey, United Kingdom
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  • Ian F. Tannock MD, PhD, DSc,

    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Eitan Amir MD, PhD

    Corresponding author
    1. Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • Corresponding author: Dr. Eitan Amir, Princess Margaret Cancer Centre, Division of Medical Oncology, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Fax: (416) 946-4563; eitan.amir@uhn.ca

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  • We thank Roy Lee from the PM central pharmacy, Darlene Dale from the PM Registry, and Jonathan Ng from the electronic data warehouse for assistance in extracting data.

  • Results of this study were presented in part at the European Cancer Congress 2013 (ECCO-ESMO-ESTRO) in Amsterdam, Netherlands, September 27-October 1, 2013 (poster discussion and poster presentation).

  • See editorial on pages 3272–4, this issue.

Abstract

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, has been reported to be a poor prognostic indicator in prostate cancer. Here we explore the use of the NLR to establish a simple prognostic score for men with metastatic castration-resistant prostate cancer (mCRPC) treated with docetaxel. METHODS: In the training cohort, the NLR and other known prognostic variables were evaluated among a cohort of chemotherapy-naïve patients treated with thrice-weekly docetaxel at the Princess Margaret Cancer Centre. Significant prognostic variables identified by univariable Cox regression were evaluated by the area under the receiver operating characteristic curves. Multivariable Cox regression was then used to derive a prognostic score where 1 risk point was assigned for each significant variable. The model was externally validated in a cohort of patients treated at the Royal Marsden. RESULTS: Three hudred fifty-seven patients were analyzed in the training cohort. Median age was 71 years, 12% had liver metastasis, and median overall survival (OS) was 14.7 months. Liver metastases, hemoglobin <12 g/dL, alkaline phosphatase >2.0× upper limit of normal (ULN), lactate dehydrogenase >1.2× ULN, and NLR >3 were associated with significantly worse OS in multivariable analysis. Four risk categories were subsequently established with 0, 1, 2, and 3-5 points. Two-year OS rates for these categories were 43%, 37%, 12%, and 3%, respectively. Area under the curve for the training cohort was 0.78 (95% CI, 0.72-0.84) compared with 0.66 (95% CI, 0.58-0.74) for the 215 patients in the validation cohort. CONCLUSIONS: This simple risk score provides good prognostic and discriminatory accuracy for men with mCRPC. Cancer 2014;120:3346–3352. © 2014 American Cancer Society.

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