Introduction: Prostate cancer is one of the medical problems in male population, and is the second most common cancer. According to statistics, the prevalence of prostate cancer in Europe is 214 / 100,000 and the number of cases diagnosed each year is 2.6 million. High incidence of prostate cancer in Indonesia, made it necessary to find an examination that can be used widely in major health centers with good sensitivity and specificity. Platelet and lymphocyte counts are routinely performed in most clinical laboratories around the world, therefore we evaluate whether pretreatment PLR and NLR can predict prognosis for prostate cancer patients. Methods: This study was conducted by using cross sectional analytical method in Urology Department of Urology Division of H. Adam Malik General Hospital Medan from 2012 until 2017. We analyzed 70 samples that met inclusion and exclusion criteria with Spearman correlation test in SPSS Statistic 23. Results: From 70 samples that has been analyzed, we found that 42 samples (60%) subjects were diagnosed with prostate adenocarcinoma and the other 40% with prostatic hyperplasia. Median pretreatment PLR score is 175.2 (75-553.8) and median score for pretreatment NLR 3.4 (1.4-20.5). Both pretreatment PLR and NLR had a weak negative correlation with Karnofsky score (R = -0.257, p = 0.032 and R = -0.247, p = 0.039, respectively) Conclusion: The higher number of pretreatment PLR score correlate to worse prognosis of prostate cancer patients and the higher number of pretreatment NLR score, correlate to worse prognosis of prostate cancer patients.
Prostate cancer is one of the medical problems in male population, and is the second most common cancer. Prostate cancer causes number 5 on cancer-related deaths in men worldwide. According to statistics, the prevalence of prostate cancer in Europe is 214 / 100,000 and the number of cases diagnosed each year is 2.6 million. From the data of the Indonesian Society of Urologic Oncology (ISUO) 2011 during the period 2006-2010 there were 971 patients with prostate cancer. The mean age was 68.3 years, the highest among age group 70-79 years was 37.6%. Diagnostic modalities were used primarily biopsy of 563 cases (57.9%). High incidence of prostate cancer in Indonesia, made it necessary to find an examination that can be used widely in major health centers with good sensitivity and specificity so that it can be used as a parameter in assessing prognosis prostate cancer.
Neutrophil-to-lymphocyte ratio (NLR) is the most commonly used method because it is easily accessible. Recent evidence indicates that NLR is associated with poor life expectancy in
patients with prostate cancer (PCa). Similarly with NLR,
Platelet-to-Lymphocyte (PLR) is a way that can be used to predict the prognosis of patients with prostate cancer, but is still rarely used worldwide. (
This research was conducted by using cross sectional analytical method in Urology Department of Urology Division of H. Adam Malik General Hospital Medan with data taken from medical record of outpatient department of urology of H. Adam Malik General Hospital Medan from 2012 until 2017.
Target population is Patients with prostate cancer. Accessible populations are outpatients who have been diagnosed with prostate cancer in H. Adam Malik General Hospital from 2012 until 2017. The sample of the research is a patient with a diagnosis of prostate cancer that has been done by histopathologic examination through simple random sampling technique that has met the criteria of inclusion and exclusion. Inclusion criteria are all patients with prostate cancer who have been diagnosed histopathologically in H. Adam Malik General Hospital Medan, with complete medical record data, and approve with informed consent by the patient. Exclusion criteria are incomplete medical record results (patient data in the form of address and telephone number, laboratory results of routine blood), patients with metabolic disorders such as Type 2 diabetes mellitus and haematological disorders and infections.
In this study, the normality tests were performed using Kolmogorov-Smirnov (KS) test for numerical data. The results of the KS test are listed in Table 1. It was found that prostate-specific antigen (PSA), haemoglobin, leukocyte, absolute platelet count, absolute lymphocyte count, absolute neutrophil count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), all of which have a value of p <0.05, so all the numerical variables in this study do not meet the normality assumptions, thus we use Spearman test to find the correlations between variables.
Kolmogorov-Smirnov (KS) Test Results for Numerical Data
Variable | p value |
PSA | < 0.001 |
Haemoglobin | 0.049 |
Leukocyte | 0.001 |
Absolute platelet count | 0.029 |
Absolute lymphocyte count | 0.041 |
Absolute neutrophil count | 0.011 |
PLR | < 0.001 |
NLR | < 0.001 |
Karnofsky Score | < 0.001 |
PSA =
In this study, 42 (60%) subjects were diagnosed with prostate adenocarcinoma. The characteristics of the subject are listed in
Characteristics of the Subjects
N | % | |
Anatomical Pathology Results | ||
Prostate Hyperplasia | 28 | 40% |
Prostate Adenocarcinoma | 42 | 60% |
PSA | 15 (0.8-436.7)a | |
Haemoglobin | 13.3 (8.8-15.9)a | |
Leukocyte | 7.8 (1.1-21.3)a | |
Absolute platelet count | 342 (97-642)a | |
Absolute lymphocyte count | 2 (0.5-46)a | |
Absolute neutrophil count | 7.5 (2.8-19.1)a | |
PLR | 175.2 (75-553.8)a | |
NLR | 3.4 (1.4-20.5)a | |
Karnofsky Score | 20 (0-100)a | |
Mortality | 12 | 17.1% |
*The abnormally distributed numerical data is shown in median (minimum-maximum)
PSA =
To know the correlation between pretreatment PLR and Karnofsky score as well as pretreatment NLR and Karnofsky score, Spearman correlation test was performed. It was found that both pretreatment PLR and NLR had a weak negative correlation with Karnofsky score (R = -0.257, p = 0.032 and R = -0.247, p = 0.039, respectively) The Spearman correlation test results are shown in
Spearman Correlation Test Results
Correlation Coefficient (R) | p value | |
Pretreatment PLR to Karnofsky score | -0.257 | 0.032 |
Pretreatment NLR to Karnofsky score | -0.247 | 0.039 |
Platelets and lymphocyte count are blood-based parameters that are measured regularly. Similarly with NLR, PLR is a parameter based on systemic inflammation. A number of studies have reported that independently, PLR predicts poor prognosis in patients with tumors, including gastric cancer, pancreatic cancer, ovarian cancer, colorectal cancer, non-small cell lung cancer, hepatocellular carcinoma, renal cell carisnoma, esophageal cancer. Yuksel et al and Kaynar et al reported that PLR can differentiate benign prostatic hyperplasia and prostate cancer (
In this study, we found that the higher number of pretreatment PLR score correlate to worse prognosis of prostate cancer patients. The higher number of pretreatment NLR score, correlate to worse prognosis of prostate cancer patients.