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Asian Journal of Urology, 2024, 11(2): 191-207    doi: 10.1016/j.ajur.2023.01.002
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Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with non-metastatic and metastatic prostate cancer: A meta-analysis and systematic review
Stefano Salcicciaa,Marco Frisendaa*(),Giulio Bevilacquaa,Pietro Viscusoa,Paolo Casaleb,Ettore De Berardinisa,Giovanni Battista Di Pierroa,Susanna Cattarinoa,Gloria Giorginoa,Davide Rosatia,Francesco Del Giudicea,Alessandro Sciarraa,Gianna Mariottia,Alessandro Gentiluccia
aDepartment of Urology, Sapienza Rome University, Policlinico Umberto I, 00161 Rome, Italy
bDepartment of Urology, Humanitas, 20089 Rozzano, MI, Italy
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Abstract: 

Objective: To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in prostate cancer (PCa) patients stratified in non-metastatic and metastatic diseases.

Methods: A literature search process was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In our meta-analysis, the pooled event rate estimated and the pooled hazard ratio were calculated using a random effect model.

Results: Forty-two articles were selected for our analysis. The pooled risk difference for non-organ confined PCa between high and low NLR cases was 0.06 (95% confidence interval [CI]: −0.03-0.15) and between high and low PLR cases increased to 0.30 (95% CI: 0.16-0.43). In non-metastatic PCa cases, the pooled hazard ratio for overall mortality between high and low NLR was 1.33 (95% CI: 0.78-1.88) and between high and low PLR was 1.47 (95% CI: 0.91-2.03), whereas in metastatic PCa cases, between high and low NLR was 1.79 (95% CI: 1.44-2.13) and between high and low PLR was 1.05 (95% CI: 0.87-1.24).

Conclusion: The prognostic values of NLR and PLR in terms of PCa characteristics and responses after treatment show a high level of heterogeneity of results among studies. These two ratios can represent the inflammatory and immunity status of the patient related to several conditions. A higher predictive value is related to a high NLR in terms of risk for overall mortality in metastatic PCa cases under systemic treatments.
Key words:  Prostatic neoplasm    Neutrophil-to-lymphocyte ratio    Platelet-to-lymphocyte ratio    Meta-analysis    Radical prostatectomy    Metastatic
收稿日期:  2022-05-08           接受日期:  2022-10-13      出版日期:  2024-04-20      发布日期:  2024-04-28      整期出版日期:  2024-04-20
引用本文:    
. [J]. Asian Journal of Urology, 2024, 11(2): 191-207.
Stefano Salciccia, Marco Frisenda, Giulio Bevilacqua, Pietro Viscuso, Paolo Casale, Ettore De Berardinis, Giovanni Battista Di Pierro, Susanna Cattarino, Gloria Giorgino, Davide Rosati, Francesco Del Giudice, Alessandro Sciarra, Gianna Mariotti, Alessandro Gentilucci. Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with non-metastatic and metastatic prostate cancer: A meta-analysis and systematic review. Asian Journal of Urology, 2024, 11(2): 191-207.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2023.01.002  或          http://www.ajurology.com/CN/Y2024/V11/I2/191
  
Study Cut-off groups Treatment HR (95% CI) for BPH vs. PCa Cases on the basis of T stage, n (%) OR (95% CI) for PCa diagnosis Cases on the basis of N stage, n (%) HR or OR (95% CI) for N+ disease Cases on the basis of ISUP, n (%) HR (95% CI) for ISUP 4-5 HR (95% CI) for progression after treatment HR (95% CI) for OM or CSM
Sun et al. [11] ? NLR<2.31
? NLR≥2.31		 Initial biopsy NA NA NA NA NA ? NLR<2.31
o-
1: 33 (30.8)
o-
2-5: 74 (69.2)
? NLR ≥ 2.31
o-
1: 22 (18.5)
o-
2-5: 97 (81.5)		 NA NA ? CSM: 2.0 (1.0-3.8)
? OM: 2.0 (0.8-5.4)
Zanaty et al. [8] ? NLR<3
? NLR≥3		 RP NA NA NA NA NA NA NA 0.9 (0.721-1.384) NA
Shelton et al. [12] ? Low NLR: 2.00 (SD 0.67)
? High NLR: 5.15 (SD 2.62)		 Active surveillance NA NA NA NA NA ? Low NLR
o-
1: 66 (89.2)
o-
2: 8 (10.8)
? High NLR
o-
1: 23 (95.8)
o-
2: 1 (4.2)		 NA NA NA
Vidal et al. [13] ? No cut-off RP NA NA NA NA NA NA NA 1.06 (0.97-1.17) ? CSM: 1.15 (0.81-1.65)
? OM: 1.04 (0.91-1.17)
Cao et al. [14] ? NLR<2
? NLR≥2		 RP NA ? NLR<2
o-
pT2: 362 (69.9)
o-
pT3: 148 (28.6)
o-
pT4: 8 (1.5)
? NLR≥2
o-
pT2: 298 (67.7)
o-
pT3: 126 (28.6)
o-
pT4: 16 (3.6)		 NA ? NLR<2
o-
N0: 395 (92.3)
o-
N1: 33 (7.7)
? NLR≥2
o-
N0: 326 (93.1)
o-
N1: 24 (6.9)		 NA ? NLR<2
o-
1: 99 (19.6)
o-
2: 185 (36.6)
o-
3: 95 (18.8)
o-
4-5: 126 (25.0)
? NLR≥2
o-
1: 81 (18.6)
o-
2: 145 (33.3)
o-
3: 75 (17.2)
o-
4-5: 134 (30.8)		 NA 0.600 (0.413-0.871) ? OM: 1.466 (0.607-3.542)
Nkengurutse et al. [15] ? NLR<2
? NLR≥2		 RP NA NA NA NA NA NA NA 1.131 (0.633-2.021) NA
Taussky et al. [16] ? NLR>3
? NLR≤3		 Brachytherapy NA NA NA NA NA NA NA 0.37 (0.15-0.92) NA
Langsenlehner et al. [17] ? NLR≥5
? NLR<5		 Radiotherapy NA NA NA NA NA NA NA 3.09 (1.64-5.82) ? OM: 2.16 (1.17-3.99)
Lee et al. [18] ? NLR<2.5
? NLR≥2.5		 RP NA ? NLR<2.5
o-
pT2: 836 (69.2)
o-
pT3a: 252 (20.9)
o-
≥pT3b: 120 (9.9)
? NLR≥2.5
o-
pT2: 78 (49.4)
o-
pT3a: 47 (29.7)
o-
≥pT3b: 33 (20.9)		 NA NA HR: 0.819 (0.303-2.216) ? NLR<2.5
o-
1: 616 (51.0)
o-
2-3: 429 (35.5)
o-
4-5: 163 (13.5)
? NLR≥2.5
o-
1: 63 (39.9)
o-
2-3: 48 (30.4)
o-
4-5: 47 (29.7)		 1.750 (0.960-3.189) 1.358 (1.008-1.829) NA
Jang et al. [19] ? NLR<1.76
? NLR≥1.76		 RP NA ? NLR<1.76
o-
pT2: 484 (47.3)
o-
pT3: 540 (52.7)
? NLR≥1.76
o-
pT2: 476 (45.6)
o-
pT3: 567 (54.4)		 NA NA NA ? NLR<1.76
o-
1-3: 812 (79.3)
o-
4-5: 212 (20.7)
? NLR≥1.76
o-
1-3: 802 (76.9)
o-
4-5: 241 (23.1)		 NA 1.099 (0.944-1.278) ? CSM: 2.012 (1.222-3.310)
? OM: 1.650 (1.127-2.416)
Jang et al. [20] ? NLR<3.5
? NLR≥3.5		 RP NA ? NLR<3.5
o-
pT2: 708 (44.8)
o-
pT3: 871 (55.2)
? NLR≥3.5
o-
pT2: 227 (50.1)
o-
pT3: 226 (49.9)		 NA NA NA ? NLR<3.5
o-
1-3: 483 (30.6)
o-
4-5: 1096 (69.4)
? NLR≥3.5
o-
1-3: 138 (30.5)
o-
4-5: 315 (69.5)		 NA 1.270 (1.066-1.514) NA
Zhang et al. [21] ? NLR<2.36
? NLR≥2.36		 RP NA ? NLR<2.36
o-
pT2: 127 (78.9)
o-
pT3-4: 34 (21.1)
? NLR≥2.36
o-
pT2: 43 (56.6)
o-
pT3-4: 33 (43.4)		 NA ? NLR<2.36
o-
N0: 152 (94.4)
o-
N1: 9 (5.6)
? NLR≥2.36
o-
N1: 15 (19.7)
o-
N0: 61 (80.3)		 NA ? NLR<2.36
o-
1: 34 (21.1)
o-
2-3: 75 (46.6)
o-
4-5: 52 (32.3)
? NLR≥2.36
o-
1: 13 (17.1)
o-
2-3: 31 (40.8)
o-
4-5: 32 (42.1)		 NA 1.388 (0.909-2.118) NA
?zsoy et al. [22] ? NLR≥3
? NLR<3		 RP NA ? NLR≥3
o-
cT1: 1565 (91.7)
o-
cT2: 114 (6.7)
o-
cT3: 1 (0.1)
? NLR<3
o-
cT1: 5320 (93.0)
o-
cT2: 302 (5.3)
o-
cT3: 2 (0.1)		 1.60 (1.30-1.95) NA OR: 1.43 (1.20-1.72) ? NLR≥3
o-
1: 344 (20.2)
o-
2-3: 1116 (65.4)
o-
4-5: 247 (14.5)
? NLR<3
o-
ISUP 1: 1888 (33.0)
o-
ISUP 2-3: 3487 (61.0)
o-
ISUP 4-5: 339 (5.9)		 2.32 (1.90-2.83) NA NA
Adhyatma et al. [23] ? NLR≥3.08
? NLR<3.08		 Initial biopsy 2.856 (1.734 -4.702) NA NA NA NA NA NA NA NA
Masuda et al. [24] ? NLR≤1.92
? NLR>1.92		 Biopsy 2.44 (1.19-5.17) NA NA NA NA NA NA NA NA
Huang et al. [25] ? NLR<2.44
? NLR≥2.44		 Initial biopsy 1.640 (1.045-2.573) NA NA NA NA ? NLR<2.44
o-
1-2: 47 (33.1)
o-
3-4: 95 (66.9)
? NLR≥2.44
o-
1-2: 61 (34.9)
o-
3-5: 114 (65.1)		 NA NA NA
Oh et al. [26] ? No cut-off Initial biopsy 1.372 (1.017-1.850) NA NA NA NA NA NA NA NA
Hashimoto et al. [27] ? No cut-off Biopsy 1.29 (0.874-1.9) NA NA NA NA NA NA NA NA
  
Study Cut-off groups Treatment HR (95% CI) for pretreatment vs. posttreatment Cases on the basis of ISUP, n (%) Cases on the basis of progression after treatment, n (%) HR (95% CI) for progression after treatment HR (95% CI) for OM
Lolli et al. [28] ? NLR<3
? NLR≥3		 Abiraterone NA NA NA NA ? Low-High (<3-≥3): 1.49 (0.84-2.63)
? High-Low (≥3-<3): 3.22 (1.89-5.49)
Onal et al. [29] ? NLR<3.1
? NLR≥3.1		 Abiraterone ? Low-high: 1.55 (0.64-3.74)
? High-low: 3.96 (1.26-12.47)		 ? 1-3:
o-
NLR<3.1: 25 (54.3)
o-
NLR≥3.1: 21 (45.7)
? 4-5:
o-
NLR<3.1: 25 (44.6)
o-
NLR≥3.1: 31 (55.4)		 NA ? 2.25 (1.44-3.51) ? 3.13 (1.67-5.88)
Bauckneht et al. [30] ? NLR<4.8
? NLR≥4.8		 Radium-223 NA NA NA NA ? 1.09 (1.00-1.20)
Bauckneht et al. [31] ? NLR<3.1
? NLR≥3.1		 Radium-223 NA NA NA NA ? 2.70 (2.06-3.56)
Pei et al. [32] ? NLR≤3.3
? NLR>3.3		 Docetaxel NA NA NA ? 1.831 (1.087-3.085) ? 2.056 (1.007-4.200)
Sonpavde et al. [33] ? NLR<2.5
? NLR 2.5 to <5
? NLR≥5		 Sunitinib NA NA NA NA ? 1.55 (1.32-1.83)
Buttigliero et al. [34] ? NLR≤3
? NLR>3		 Docetaxel NA NA ? NLR≤3: 39/46 (84.8)
? NLR>3: 57/64 (89.1)		 ? 1.57 (0.84-2.92) ? 3.16 (1.50-6.65)
Kawahara et al. [35] ? NLR>3.02
? NLR≤3.02		 Abiraterone and/or enzalutamide NA NA NA NA ? 2.115 (1.540-2.906)
Chong et al. [36] ? NLR<2.65
? NLR≥2.65		 ARTA and docetaxel NA NA ? NLR<2.65: 14/21 (66.7)
? NLR≥2.65: 31/42 (73.8)		 ? 1.65 (0.87-3.12) ? 3.27 (1.11-9.63)
Lorente et al. [37] ? NLR>3
? NLR<3		 Mitoxantrone and cabazitaxel NA NA NA ? BCP: 1.35 (1.12-1.62)
? RCP: 1.42 (1.15-1.76)		 ? 1.55 (1.30-1.84)
Uemura et al. [38] ? NLR<3.83
? NLR≥3.83		 Cabazitaxel NA NA NA NA ? 3.01 (1.06-8.49)
Templeton et al. [39] ? NLR<3
? NLR>3		 Docetaxel NA NA NA NA ? 1.89 (1.27-2.82)
Boegemann et al. [40] ? NLR<5
? NLR>5		 Abiraterone NA ? 4-5:
o-
NLR<5: 46 (60.5)
o-
NLR>5: 9 (56.3)		 NA ? 3.4 (0.8-15.2) ? 1.6 (0.5-5.6)
Conteduca et al. [41] ? NLR<3
? NLR≥3		 Abiraterone and/or enzalutamide NA NA NA ? 1.98 (1.54-2.56) ? 2.04 (1.54-2.70)
Yasui et al. [42] ? NLR<3.76
? NLR≥3.76		 Abiraterone NA ? NLR<3.76:
o-
1: 1 (2.0)
o-
2-3: 7 (14.0)
o-
4-5: 42 (84.0)
? NLR≥3.76:
o-
1: 0 (0)
o-
2-3: 6 (20.0)
o-
4-5: 24 (80.0)		 NA NA ? 2.506 (1.106-5.68)
Fan et al. [43] ? NLR≥3
? NLR<3		 Abiraterone and docetaxel NA ? NLR≥3:
o-
1-3: 25 (40.3)
o-
4-5: 37 (59.7)
? NLR<3:
o-
1-3: 23 (54.8)
o-
4-5: 19 (45.2)		 NA NA NA
  
Study Cut-off groups Treatment HR (95% CI) for BPH vs. PCa HR (95% CI) for pretreatment vs. posttreatment Cases on the basis of T stage, % Cases on the basis of ISUP, % Cases on the basis of treatment, n (%) HR (95% CI) for progression after treatment HR (95% CI) for OM or CSM
Sun et al. [11] ? Low PLR<134
? High PLR≥134		 Initial biopsy NA NA NA ? Low PLR
o-
1: 31.6
o-
2-5: 68.4
? High PLR
o-
1: 16.5
o-
2-5: 83.5		 NA NA ? CSM: 1.30 (0.60-2.80)
? OM: 2.10 (0.80-4.90)
Zanaty et al. [8] ? Low PLR<190
? High PLR≥190		 RP NA NA NA NA NA BCP: 0.997 (0.988-1.006) NA
Shelton et al. [12] Active surveillance NA NA NA ? Low PLR
o-
1: 90.0
o-
2: 10.0
? High PLR
o-
1: 92.0
o-
2: 8.0		 NA NA NA
Ferro et al. [44] ? Low PLR<118
? High PLR≥118		 RP and active surveillance NA NA NA ? 2-5
o-
PLR<118: 29.9
o-
PLR≥118: 44.2		 NA NA NA
Vidal et al. [13] NA RP NA NA NA NA NA NA ? CSM: 1.00 (0.99-1.01)
? OM: 1.00 (0.98-1.03)
Shu et al. [45] ? Low PLR<100.7
? High PLR≥100.7		 RP NA NA NA NA ? BCP:
o-
Low PLR: 184/380 (48.4)
o-
High PLR: 196/380 (51.6)		 NA NA
Nkengurutse et al. [15] ? Low PLR<120.4
? High PLR≥120.4		 RP NA NA NA NA NA BCP: 1.020 (0.575-1.811) NA
Lee at al. [46] NA Initial biopsy 0.094 (0.003-2.900) NA NA NA NA NA
Wang et al. [47] ? Low PLR<117.58
? High PLR≥117.58		 ADT NA NA NA ? Low PLR<117.58
o-
≤7: 52.0
o-
>7: 48.0
? High PLR≥117.58
o-
≤7: 47.0
o-
>7: 53.0		 NA RCP: 1.581 (1.100-2.272) ? CSM: 1.768 (1.036-3.015)
? OM: 1.650 (1.013-2.687)
Li et al. [48] ? Low PLR<150
? High PLR ≥150		 Initial biopsy NA 2.67 (1.73-4.92) ? PCa: T3
o-
Low PLR: 41.8
o-
High PLR: 75.0		 ? 4-5
o-
Low PLR: 53.7
o-
High PLR: 58.3		 NA NA NA
Langsenlehner et al. [49] ? Low PLR<190
? High PLR≥190		 Radiotherapy NA NA NA NA NA NA ? CSM: 3.99 (1.19-13.4)
? OM: 1.87 (1.02-3.42)
Adhyatma et al. [50] ? Low PLR<143
? High PLR≥143		 Initial biopsy 1.152 (0.648-2.049) NA NA NA NA NA NA
Masuda et al. [24] ? Low PLR<101.3
? High PLR≥101.3		 Initial biopsy 1.710 (0.810-3.630) NA NA NA NA NA NA
  
Study Cut-off groups Treatment HR (95% CI) for pretreatment vs. posttreatment Cases on the basis of ISUP, % Cases on the basis of progression after treatment, n (%) HR (95% CI) for progression after treatment HR (95% CI) for OM
Onal et al. [29] ? Low PLR<163
? High PLR≥163		 ARTA (abiraterone) ? Low-high: 0.90 (0.38-2.13)
? High-low: 1.39 (0.49-3.92)		 ? PLR<163
o-
≤7: 59
o-
>7: 41
? PLR≥163- ≤7: 41- >7: 59		 NA 0.88 (0.56-1.37) ? 1.02 (0.56-1.87)
Shi et al. [51] ? Low PLR<104.275
? High PLR≥104.275		 Chemotherapy (docetaxel) NA NA NA NA ? Poor vs. favorable: 28.606 (9.390-87.144)
? Poor vs. intermediate: 7.412 (2.406-22.808)
Bauckneht et al. [30] ? Low PLR<241
? High PLR≥241		 Radium-223 NA NA NA NA ? 1.03 (0.90-1.18)
Chong et al. [36] ? Low PLR<155.54
? High PLR≥155.54		 ARTA and chemotherapy NA NA ? Low PLR<155.54: 14/23 (60.9%)
? High PLR≥155.54: 31/40 (77.5%)		 1.72 (0.91-3.24) ? 2.38 (0.88-6.43)
Lolli et al. [28] ? Low PLR<210
? High PLR≥210		 ARTA (abiraterone) NA NA NA NA ? Low-high (<210-≥210): 1.54 (0.71-3.33)
? High-low (≥210-<210): 1.46 (0.91-2.36)
  
  
  
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