Neutrophil-to-Lymphocyte Ratio Predicts PSA Response and Prognosis in Prostate Cancer: A Systematic Review and Meta-Analysis.
Neutrophil-to-Lymphocyte Ratio Predicts PSA Response and Prognosis in Prostate Cancer: A Systematic Review and Meta-Analysis.
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DOI：
10.1371/journal.pone.0158770
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Xu R
中科院分区：
文献类型：
--
作者：
Cao J;Zhu X;Zhao X;Li XF;Xu R
在过去的几年里，耐去势前列腺癌(CRPC)的治疗取得了前所未有的进展。随着一些新药物的批准，迫切需要开发更好的预后生物标志物，以促进这些新药物的个性化选择和测序。越来越多的证据表明，前列腺癌(PCa)患者的中性粒细胞/淋巴细胞比率(NLR)与较差的生存有关。然而，NLR在预测PSA应答(PSARS)和生化复发(BCR)方面的重要性在很大程度上被忽视了。在这里，我们进行了系统的回顾和荟萃分析，以评估NLR对PSARS、BCR和PCa生存的预后价值。利用EMBASE、PubMed、Cochrane图书馆和中国国家知识基础设施进行系统的数据库检索。Meta分析通过合并风险比(HR)、优势比(OR)和相应的95%可信区间(CI)进行。共有22项研究被纳入荟萃分析。我们的结果表明，NLR升高预示着较低的PSARS发生率(OR=1.69，95%CI：1.40~1.98)和较高的BCR可能性(HR=1.12，95%CI：1.02~1.21)。此外，我们证实，NLR升高是转移性去势抵抗前列腺癌(MCRPC)(HR=1.45，95%CI：1.32-1.59)和局限性PCa(HR=1.12，95%CI：1.01-1.23)总体生存期(OS)缩短的预后指标，它预示着CRPC(HR=1.42，95%CI：1.23-1.61)较差的无进展生存率(PFS)和较差的无复发生存率(RFS)(HR=1.38，95%可信区间：1.01~1.75)。我们的结果提示，NLR升高可作为生化变化和预后的预后指标，以利于PCa患者个体化治疗的危险分层和决策。对潜在的机制和未来的研究方向也进行了讨论。
An unprecedented advance has been seen in castration-resistant prostate cancer (CRPC) treatments in the past few years. With a number of novel agents were approved, there is a pressing need to develop improved prognostic biomarkers to facilitate the personalised selection and sequencing of these novel agents. Emerging evidence indicates that the neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival in patients with prostate cancer (PCa). However, the importance of the NLR for the prediction of the PSA response (PSARS) and biochemical recurrence (BCR) has been largely neglected. Here, we conducted a systematic review and meta-analysis to evaluate the prognostic value of the NLR for the PSARS, BCR, and survival in PCa. A systematic database search was performed using Embase, PubMed, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI). A meta-analysis was performed by pooling hazard ratios (HRs), odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). A total of 22 studies were included in the meta-analysis. Our results suggest that an elevated NLR predicts a lower PSARS rate (OR = 1.69, 95% CI: 1.40–1.98) and a higher possibility of BCR (HR = 1.12, 95% CI: 1.02–1.21). Additionally, we confirmed that an elevated NLR was a prognostic predictor of shorter overall survival (OS) in both metastatic castration-resistant PCa (mCRPC) (HR = 1.45, 95% CI: 1.32–1.59) and localized PCa (LPC) (HR = 1.12, 95% CI: 1.01–1.23) and that it predicted worse progression-free survival (PFS) in CRPC (HR = 1.42, 95% CI: 1.23–1.61) and poorer recurrence-free survival (RFS) (HR = 1.38, 95%CI: 1.01–1.75) in LPC. Our results suggest that an elevated NLR might be employed as a prognostic marker of biochemical changes and prognosis to facilitate risk stratification and decision making for individual treatment of PCa patients. The potential mechanisms underlying these associations and future research directions are also discussed.