Baseline Neutrophil-Lymphocyte Ratio (NLR) is Associated with Survival and Response to Treatment with Second-Line Chemotherapy for Advanced XXXX Independent of Baseline Steroid Use.

@entity1 @entity263 @entity3012 @entity5 @entity2664 @entity2357 @entity15513 @entity288
BACKGROUND: The neutrophil-lymphocyte ratio (NLR), proposed as an indicator of @entity5 , has known prognostic value in @entity263 . We examine its association with survival ( @entity3012 ) and response in @entity1 treated with second-line chemotherapy. METHODS: We analyzed @entity1 with metastatic castration-resistant @entity263 (mCRPC) treated in the TROPIC trial, evaluating @entity15513 versus @entity2664 . Cox-regression models were used to investigate the association of baseline NLR (BLNLR) with @entity3012 and the significance of a change in NLR count with treatment. @entity2357 models were used to determine the association of baseline NLR counts with PSA and RECIST responses. The optimal NLR cut-off was established based on the concordance index of different values. RESULTS: Data from 755, 654 and 405 @entity1 was available for @entity3012 , PSA and RECIST response analysis respectively. Median @entity3012 was 14.0 months (95%CI 13.2-14.8). Median NLR was 2.9 (IQR:1.9-5.1). BLNLR was associated with survival (HR 1.5, 95%CI 1.1-2.1, p=0.011) in multivariable analysis (MVA) independently of variables included in the Halabi nomogram, treatment arm and corticosteroid use. The optimal cut-off for a dichotomous NLR was selected at 3.0 based on its higher c-index related to survival. BLNLR >= 3.0 was associated with lower PSA response (40.1% vs 59.9%; p<0.001) and RECIST response (7.7% vs 15.6%, p=0.022) in MVA. Conversion from high (>= 3) to low (< 3) NLR was associated with improved survival (HR 0.66; 95% CI 0.51 - 0.85; p=0.001) and higher PSA response rates (66.4% vs 33.6%; p=0.000). Use of @entity288 at baseline did not modify the association between NLR and survival. CONCLUSIONS: NLR is a valid prognostic biomarker in CRPC and is associated with survival, PSA and RECIST responses in @entity1 treated with second-line chemotherapy. Changes in NLR counts with treatment may indicate benefit. NLR prognostic value is independent of prior use of @entity288 .
