CUAJ Letters is an open forum to discuss papers published in CUAJ. Letters are published at the discretion of the editors, and are subject to abridgement and editing for style and content. Letters can be sent to the Editor at journal@cua.org.
We read with great interest the article, “Evaluation of neutrophil-to-lymphocyte ratio prior to prostate biopsy to predict biopsy histology: Results of 1836 patients,” by Gokce et al.1 Investigators aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) prior to prostate biopsy to predict biopsy histology and Gleason score in patients with prostate cancer.
The mean NLR of the prostate cancer group was significantly higher than that of the benign prostatic hypertrophy (BPH) group (p=0.002). The mean NLR of the prostatitis group was higher than that of both the prostate cancer and BPH groups (p=0.0001). The mean NLR of the Gleason score (GS) 8–10 group was higher than that of the GS 7 and GS 5–6 groups. The authors conclude that NLR was found to vary with regard to histology of prostate biopsy and higher GS was associated with higher NLR in patients with prostate cancer.
Complete blood count is a inexpensive, comparatively routine, and practical laboratory test that gives us important information about the patient’s formed blood contents. Routine peripheral blood counts may be useful in diagnosis and prognosis of many disorders, including prostatic diseases.2–12
NLR is measured by dividing the number of neutrophils by the number of lymphocytes. NLR may be an indicator of systemic inflammation, as neutrophils and lymphocytes are thought to be significant in tumour immunology and inflammation. Inflammation plays a significant role in the proliferation, angiogenesis, and metastasis of cancer cells and is important in the development and progression of the disease.2,3 Even when white blood cell count is in normal range, NLR has been demonstrated to play a predictive role in the prognosis of chronic and acute inflammatory processes.2–12
A recent meta-analysis study concludes that a high NLR is an independent factor associated with poorer overall survival in many solid tumours (colorectal, hepatocellular, gastroesophageal, ovarian, and pancreatic carcinoma). This marker may be associated with renal or hepatic dysfunction, diabetes mellitus, abnormal thyroid function, hypertension, metabolic syndrom, hematological malignancies, known malignancy, preceding history of local or systemic infection, inflammatory diseases, and any use of medication connected to inflammatory status of patients. 9–12 The authors should have mentioned these factors.
In conclusion, we strongly believe the findings obtained from the current study will lead to further studies examining the evaluation of NLR prior to prostate biopsy to predict biopsy histology.
Footnotes
Competıng ınterests: The authors declare no competing financial or personal interests.
References
- 1.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;9:E761–5. doi: 10.5489/cuaj.3091. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl LekListy. 2001;102:5–14. [PubMed] [Google Scholar]
- 3.Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883–99. doi: 10.1016/j.cell.2010.01.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Ozcan C, Telli O, Ozturk E, et al. The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer. Can Urol Assoc J. 2015;9:E789–94. doi: 10.5489/cuaj.3061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Maeda Y, Kawahara T, Kumano Y, et al. The neutrophil-to-lymphocyte ratio before repeat prostate needle biopsy for predicting prostate cancer. Urol Int. 2015 Dec 16; doi: 10.1159/000442895. [Epub ahead of print] [DOI] [PubMed] [Google Scholar]
- 6.Kaynar M, Yıldırım ME, Badem H, et al. Bladder cancer invasion predictability based on preoperative neutrophil–lymphocyte ratio. Tumour Biol. 2014;35:6601–5. doi: 10.1007/s13277-014-1889-x. [DOI] [PubMed] [Google Scholar]
- 7.Demirer Z, Uslu AU. More work needed in examining the relationship between mean platelet volume and inflammation in varicocele pathophysiology. Can Urol Assoc J. 2015;9:E639. doi: 10.5489/cuaj.3114. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumours: A systematic review and meta-analysis. J Natl Cancer Inst. 2014;106 doi: 10.1093/jnci/dju124. dju124. [DOI] [PubMed] [Google Scholar]
- 9.Balta S, Demirer Z, Aparci M, et al. The relation between lymphocyte-monocyte ratio and renal cell carcinoma. Urol Oncol. 2015;33:421. doi: 10.1016/j.urolonc.2015.05.004. [DOI] [PubMed] [Google Scholar]
- 10.Demirer Z, Uslu AU. Predictive value of neutrophil-lymphocyte ratio in non-muscle-invasive bladder cancer. Urol Oncol. 2016;34:1–2. doi: 10.1016/j.urolonc.2015.09.006. [DOI] [PubMed] [Google Scholar]
- 11.Balta S, Demırer Z, Aparci M, et al. The lymphocyte-monocyte ratio in clinical practice. J Clin Pathol. 2016;69:88–9. doi: 10.1136/jclinpath-2015-203233. [DOI] [PubMed] [Google Scholar]
- 12.Demirer Z, Uslu AU, Balta S. Letter to the editor: Predictive value of the neutrophil-lymphocyte ratio and mean platelet volume in testicular torsion. Korean J Urol. 2015;56:601–2. doi: 10.4111/kju.2015.56.8.601. [DOI] [PMC free article] [PubMed] [Google Scholar]