Neutrophil-to-Lymphocyte ratio

[pjoshea13]

New study [1] below.

There has been a recent spate of studies showing that various markers of inflammation affect the outcome of many diseases. Indeed, 5-year survival in seemingly healthy individuals is affected by inflammation.

All of the papers I have read, write of the usefulness of inflammation markers for prognostic purposes. e.g. in a hospital setting, identifying patients who might have an unexpective response to treatment. I can see why inflammation might be thought of as a disease symptom, but I don't understand why there is no interest in treating it as a separate problem.

In PCa & other cancers, a common cell survival mechanism is activated. Nuclear Factor-kappaB [NF-kB] sits in the cell, bound to a protein that prevents it translocating to the nucleus. In times of bacterial or viral insult, NF-kB will be spilt from the protein & will head to the nucleus. All sorts of protective proteins will then be produced, including enzymes that will act on the arachidonic acid stored in the cell, to form inflammatory metabolytes. PCa chronically activates NF-kB. Inflammation can be tamed by NF-kB inhibitors. All of the common polyphenols are NF-kB inhibitors.

The Neutrophil-to-Lymphocyte ratio [NLR] is part of most blood test panels used at annual medicals. I imagine that most of us ignore it. It is indicative of inflammation.

From 2014, a NLR/solid tumor meta-analysis [2]:

"One hundred studies comprising 40559 patients were included in the analysis, 57 of them published in 2012 or later."

"Median cutoff for NLR was 4. Overall, NLR greater than the cutoff was associated with a hazard ratio for {overall survival} of 1.81 .., an effect observed in all disease subgroups, sites, and stages."

"Hazard ratios for NLR greater than the cutoff for":

... cancer-specific survival = 1.61

... progression-free survival = 1.63

... disease-free survival = 2.27

In the new study [1], we have a meta-analysis of 22 PCa studies:

"Our results suggest that an elevated NLR predicts a lower {PSA response} rate (OR = 1.69 ...) and a higher possibility of {biochemical recurrence} (HR = 1.12 ...). 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 ...) and localized PCa (LPC) (HR = 1.12 ...) and that it predicted worse progression-free survival (PFS) in CRPC (HR = 1.42 ...) and poorer recurrence-free survival (RFS) (HR = 1.38 ...) in LPC."

My contention is that an unfavorable NLR can be lowered - along with the risk.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/273...

[2] jnci.oxfordjournals.org/con...