Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy

// Takashi Kawahara 1, 2, * , Sachi Fukui 1, * , Kentaro Sakamaki 3 , Yusuke Ito 1 , Hiroki Ito 1 , Naohito Kobayashi 1 , Koji Izumi 1 , Yumiko Yokomizo 1 , Yasuhide Miyoshi 2 , Kazuhide Makiyama 1 , Noboru Nakaigawa 1 , Takeharu Yamanaka 3 , Masahiro Yao 1 , Hiroshi Miyamoto 4 , Hiroji Uemura 1, 2 1 Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan 2 Departments of Urology and Renal Transportation, Yokohama City University Medical Center, Yokohama, Japan 3 Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan 4 Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, USA * These authors have contributed equally to this work Correspondence to: Takashi Kawahara, e-mail: takashi_tk2001@yahoo.co.jp Keywords: Clinical Section, prostate cancer, biomarker, neutrophil-to-lymphocyte ratio, prostate needle biopsy Received: June 08, 2015 Accepted: August 06, 2015 Published: August 20, 2015 ABSTRACT Neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammatory response, has been demonstrated as an independent prognosticator for some solid malignancies, including prostate cancer. In the present study, we evaluated the role of NLR in men who underwent prostate needle biopsy for their initial diagnosis of prostatic carcinoma. Both complete blood counts and free/total (F/T) prostate-specific antigen (PSA) ratio were examined in a total of 3,011 men in our institution. Of these, 1,207 had a PSA level between 4 and 10 ng/mL, and 357 of 810 who subsequently underwent prostate needle biopsy were found to have prostatic adenocarcinoma. NLR value was significantly higher in men with PSA of ≥ 20 ng/mL than in those with PSA of < 20 ng/mL ( p < 0.001). NLR was also significantly higher in men with positive biopsy than in those with negative biopsy ( p < 0.001). Using NLR cut-off point of 2.40 determined by the AUROC curve, positive/negative predictive values of NLR alone and NLR combined with F/T PSA ratio (cut-off: 0.15) were 56.6%/60.8% and 80.7%/60.1%, respectively. Multivariate analysis revealed that not only F/T PSA ratio ( HR = 3.13) but also NLR ( HR = 2.21) was an independent risk factor for prostate cancer. NLR is thus likely elevated in patients with prostate cancer. Accordingly, NLR, with or without combination with F/T PSA ratio, may function as a new biomarker to predict prostate cancer in men undergoing prostate needle biopsy.