Prostat Kanseri Tanısında Kan Nötrofil / Lenfosit Dağılımının Yeri

Abstract

Amaç: Nötrofil lenfosit oranı (NLR) son zamanlarda oldukça popüler olan tanısal bir belirteçtir. Bu makalede NLR’nin prostat kanseri tanısındaki yeri, cut off değeri yanında platelet lenfosit oranı (PLR), Gleason skoru ve biyopside saptanan tümör yüzdesi ile ilişkisi değerlendirildi. Ayrıca transrektal ultrason (TRUS) eşliğinde biyopsi yapılan hastaların bulguları paylaşıldı.
Gereç ve Yöntemler: Kliniğimizde 2014 ağustos – 2017 şubat tarihlerinde, prostat spesifik antijen (PSA) değerleri 2.5ng/ml ve üzeri olup TRUS eşliğinde prostat biyopsisi yapılan 679 hastanın sonuçları retrospektif olarak incelendi. Hastalar PSA değerlerine göre 2.5-3.9 ng/ml arası (Grup 1), 4-9.9 ng/ml arası (Grup 2), 10-19.9 ng/ml arası (Grup 3), 20 ng/ml ve üzeri (Grup 4) olarak dört gruba ayrıldı. NLR’nin bu gruplarda patoloji sonuçlarına göre tanısal değeri incelendi.
Bulgular: NLR, grup 2,3 ve 4’te diagnostik bir belirteç olarak bulundu. Cut off değeri 2.5 olarak hesaplandı. PLR ile benzer tanısal güce sahipti. Gleason skoru ve her bir core tümör yüzdesi ile zayıf bir korelasyonu vardı. Kemik metastazını öngörmede bir öneme sahip değildi. PSA dansitesi ve rektal tuşe bulguları arasındaki fark, patolojisi prostat kanseri (PCa) veya benign prostat hiperplazisi (BPH) olan gruplar da istatistiksel olarak anlamlıydı.
Sonuç: NLR PCa tanısında çok güçlü olmasa da diagnostik bir değere sahiptir. PSA’ yı destekleyici bir belirteç olarak kullanılabilir.   

Keywords

• Prostat kanseri,Prostat biyopsisi,Nötrofil lenfosit oranı

The Role Of Blood Neutrophil / Lymphocyte Distribution in The Diagnosis Of Prostate Cancer

Abstract

Objective: Neutrophil to lymphocyte ratio (NLR) is a recently popular diagnostic marker. We sought answers to questions such as whether this marker has a role in the diagnosis of prostate cancer, any cut off value can be calculated, compared to platelet lymphocyte ratio (PLR) and it has a relationship with Gleason score and percentage of tumors detected in biopsy cores. In addition, we aimed to share the findings of patients undergoing transrectal ultrasound (TRUS) guided biopsy.
Materials and Methods: The results of 679 patients who underwent TRUS-guided prostate biopsy with prostate specific antigen (PSA) values above 2.5 ng / ml in our clinic between August 2014 and February 2017 were retrospectively analyzed. Patients were between 2.5-3.9 ng / ml (Group 1), 4-9.9 ng / ml (Group 2), 10-19.9 ng / ml (Group 3), 20 ng / ml and above (Group 4) according to PSA values, divided into four groups. The diagnostic value of NLR was evaluated in these groups.
Results: NLR was found as a diagnostic marker in groups 2,3 and 4. The cut off value was calculated as 2.5. It had similar diagnostic power as PLR. There was a poor correlation with Gleason score and percentage of tumor in cores. It was not important in predicting bone metastasis. The difference between PSA density and DRE was statistically significant in groups with pathologic prostate cancer (PCa) or benign prostatic hyperplasia (BPH).
Conclusion: Although NLR is not very strong in the diagnosis of PCa, it has a diagnostic value. It can be used as a marker to support PSA.

Keywords

• Prostate cancer,Prostate biopsy,Neutrophil lymphocyte ratio

References

1. [1] Siegel R, Ma J, Zou Z, et al: Cancer statistics, 2014. CA Cancer J Clin 2014; 64: pp. 9-29.
2. [2] Ruijter E, van de Kaa C, Miller G, et al.: Molecular genetics and epidemiology of prostate carcinoma. Endocr Rev 20 (1):pp.22-45.
3. [3] Sundar S, O’Cathail M. Neutrophil-lymphocyte ratio is prognostic butnot predictive of response to Abiraterone in metastatic castrationresistantprostate cancer. JRSM Open. 2015 Nov 3;6(12):2054270415611332
4. [4] Yin X, Xiao Y, Li F, et al. Prognostic role of neutrophil-to-lymphocyteratio in prostate cancer: a systematic review and meta-analysis. Medicine(Baltimore) 2016;95:e2544.
5. [5] Gu X, Gao X, Li X, et al. Prognostic significance of neutrophil-tolymphocyteratio in prostate cancer: evidence from 16,266 patients. Sci Rep. 2016 Feb 25;6:22089
6. [6] Kawahara T, Yokomizo Y, Ito Y, et al. Pretreatment neutrophil-tolymphocyteratio predicts the prognosis in patients with metastaticprostate cancer. BMC Cancer 2016;16:111.
7. [7] Zhang GM, Zhu Y, Ma XC, et al. Pretreatment neutrophil-tolymphocyteratio: a predictor of advanced prostate cancer andbiochemical recurrence in patients receiving radical prostatectomy. Medicine (Baltimore) 2015;94:e1473.
8. [8] Huang TB, Mao SY, Lu SM, Yu JJ, Luan Y, Gu X, Liu H, Zhou GC, Ding XF. Predictive value of neutrophil-to-lymphocyteratio in diagnosis of prostate cancer among men who under went template-guided prostate biopsy: A STROBE-compliant study. Medicine (Baltimore). 2016 Nov;95(44):e5307.

9. [9] Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: a decade of discovery-what we have learned and where we are going. J Urol. 1999 Aug;162(2):293-306
10. [10] Erol B, Gulpinar MT, Bozdogan G, et al: Thecutofflevel of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: a validation study on a Turkish patient population in different age categories. Kaohsiung J MedSci 2014; 30: pp.545–550.
11. [11] Thompson IM, Pauler DK, Goodman PJ, et al: Prevalence of prostate cancer among men with a prostate specific antigen level and it; or = 4.0 ng per milliliter. N Engl J Med 2004; 350: pp.2239–2246.
12. [12] McDonald AC, Vira MA, Vidal AC, Gan W, Freedland SJ, Taioli E: Association between systemic inflammatory markers and serum prostate- specific antigen in men without prostatic disease – the 2001–2008 National Health and Nutrition Examination Survey. Prostate 2014; 74: pp.561–567.
13. [13] Ploussard G, Nicolaiew N, Marchand C, et al: Risk of repeat biopsy and prostate cancer detection after an follow –up from a prospective trial. BJU Int 2013; 111:pp. 988–996.
14. [14] Erol B, Gulpinar MT, Bozdogan G, Ozkanli S, Onem K, Mungan G, Bektas S, Tokgoz H, Akduman B, Mungan A. The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: A validation study on a Turkish patient population in different age categories. Kaohsiung J Med Sci. 2014 Nov;30(11):545-50
15. [15] Karakiewicz PI, Benayoun S, Begin LR, Duclos A, Valiquette L, McCormack M, Benard F, Saad F, Perrotte P. Chronic inflammation is negatively associated with prostate cancer and high-grade prostatic intraepithelial neoplasia on needle biopsy. International journal of clinical practice. 2007; 61:pp.425–430.
16. [16] Wolters T, Roobol MJ, Schroder FH, van der Kwast TH, Roemeling S, van der Cruijsen-Koeter IW, Bangma CH, vanLeenders GJ. Can non-malignant biopsy feature sidentify men at increased risk of biopsy-detectable prostate cancer at re-screeningafter 4 years? BJU international. 2008; 101:283
17. [17] Zorlu F, Zorlu R, Divrik RT, Eser S, Yorukoglu K. Prostate cancer incidence in Turkey: an epidemiological study. Asian Pac J Cancer Prev.2014;15(21):9125-30.
18. [18] Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role ofneutrophil-to-lymphocyte ratio in solid tumors: a systematic review andmeta-analysis. J Natl Cancer Inst 2014;106
19. [19] Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammationbasedneutrophil-lymphocyte ratio: experience in patients with cancer.Crit Rev Oncol Hematol 2013;88:pp.218–30.
20. [20] Taverna G, Pedretti E, DiCaro G, et al. Inflammation and prostate cancer: friendsorfoe? InflammRes 2015;64:pp.275–86.
21. [21] Lapi F, Levi M, Simonetti M, et al. Risk of prostate cancer in low-dose aspirin users: a retrospective cohort study. Int J Cancer 2016;139:205–11.
22. [22] VeitonmakiT, MurtolaTJ, Maattanen L, et al. Use of non-steroidal anti inflammatory drugs and prostate cancer survival in the Finnish prostate cancer screening trial. Prostate 2015;75:1394–402.
23. [23] Jacobs EJ, Newton CC, Stevens VL, et al. Daily aspirin use and prostate cancer-specific mortality in a large cohort of men with non metastatic prostate cancer. J ClinOncol 2014;32:3716–22.
24. [24] Knox JD, Cress AE, Clark V, et al: Differential expression of extracellular matrix molecules and the alpha 6-integrins in the normal and neoplastic prostate. Am J Pathol 1994; 145: pp. 167-174
25. [25] Fujita K, Imamura R, Tanigawa G, et al: Low serum neutrophil count predicts a positive prostate biopsy. Prostate Cancer Prostatic Dis 2012; 15: pp.386–390.
26. [26] Kawahara T, Fukui S, Sakamaki K, et al: Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men under going needle biopsy. Oncotarget 2015; 6: 32169–32176
27. [27] Minardi D, Scartozzi M, Montesi L, Santoni M, Burattini L, Bianconi M, Lacetera V, Milanese G, Cascinu S, Muzzonigro G. Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer. Springerplus. 2015; 4:255.
28. [28] Leibowitz-Amit R, Templeton AJ, Omlin A, Pezaro C, Atenafu EG, Keizman D, et al. Clinical variables associated with PSA response to abiraterone acetate in patients with metastatic castration-resistant prostate cancer. Ann Oncol. 2014 Mar;25(3):657-62
29. [29] Nuhn P, Vaghasia AM, Goyal J, Zhou XC, Carducci MA, Eisenberger MA, et al. Association of pretreatment neutrophil-to-lymphocyte ratio (NLR) and overall survival (OS) in patients with metastatic castration- resistant prostate cancer (mCRPC) treated with first-line docetaxel. BJU international. 2014; 114 (6b):E11–7.
30. [30] Sonpavde G, Pond GR, Armstrong AJ, Clarke SJ, Vardy JL, Templeton AJ, et al. Prognostic impact of the neutrophil-to-lymphocyte ratio in men with metastatic castration-resistant prostate cancer. Clinical genitourinary cancer. 2014; 12(5):pp.317–24
31. [31] Templeton AJ, Pezaro C, Omlin A, McNamara MG, Leibowitz-Amit R, Vera-Badillo FE, et al. Simple prognostic score for metastatic castration-resistant prostate cancer within corporation of neutrophil-to lymphocyte ratio. Cancer. 2014; 120(21):pp.3346–52.
32. [32] Zhang GM, Zhu Y, Ma XC, Qin XJ, Wan FN, Dai B, et al. Pretreatment Neutrophil-to-Lymphocyte Ratio: A Predictor of Advanced Prostate Cancer and Biochemical Recurrence in Patients Receiving Radical Prostatectomy. Medicine. 2015; 94(41):e1473.
33. [33] Bahig H, Taussky D, Delouya G, Nadiri A, Gagnon-Jacques A, Bodson-Clermont P, et al. Neutrophil count is associated with survival in localized prostate cancer. BMC cancer. 2015; 15(1):594.
34. [34] Gokce MI, Hamidi N, Suer E, et al. Evaluation of neutrophil-to lymphocyte ratio prior to prostate biopsy to predict biopsy histology: results of 1836 patients. Can Urol Assoc J. 2015 Nov-Dec;9(11-12):E761-5
35. [35] Sciarra A, Mariotti G, Salciccia S, et al. Prostate growth and inflammation. J Steroid Biochem MolBiol 2008;108:pp.254–60.
36. [36] Huang TB, Mao SY, Lu SM, Yu JJ, Luan Y, Gu X, Liu H, Zhou GC, Ding XF. Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of prostate cancer among men who under went template-guided prostate biopsy: A STROBE-compliant study.Medicine (Baltimore) 2016Nov;95(44):e5307.