Immunological markers as predictors of locally advanced disease and biochemical recurrence in patients with intermediate-risk prostate cancer after radical prostatectomy

Background. Systemic inflammation is considered as a significant factor in the pathogenesis and progression of prostate cancer. Despite the leading role of standard clinical and laboratory parameters in assessing the aggressiveness of the disease, literature data demonstrate potential prognostic value of immunological markers, however, their significance in intermediate risk group remains insufficiently studied.

Aim. To evaluate the association of neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) ratios and the systemic immune inflammation index (SII) with oncological outcomes in patients with intermediate-risk prostate cancer after radical prostatectomy.

Materials and methods. A retrospective analysis of the treatment results of 167 patients with morphologically confirmed intermediate risk prostate cancer who underwent laparoscopic radical prostatectomy in 2019–2023 was performed. The association of preoperative immunological markers with pathomorphological characteristics, stage of the disease after surgery, frequency of biochemical recurrence (BCR) and recurrence-free survival was evaluated. Mann–Whitney tests, Pearson’s χ², ROC analysis, Kaplan–Mayer analysis, and Cox regression were used to identify associations and assess the predictive significance of markers.

Results. With a median follow-up of 32.7 months, the incidence of BCR was 10.8 % of cases. Neither NLR nor LMR demonstrated a statistically significant association with aggressive pathomorphological features or BCR. However, patients with a locally advanced process had lower SII values (p = 0.0437). Patients with BCR also had lower median SII (p = 0.0108) and PLR (p = 0.0346). Using ROC analysis, threshold levels were determined: PLR <98.2 and SII <360.6. Patients with SII <360.6 had a higher risk of BCR, confirmed by multivariable analysis (hazard ratio 5.7; p = 0.0342). At the same time, the PLR did not demonstrate a prognostic value in relation to BCR.

Conclusion. NLR and LMR have no prognostic value in relation to aggressive forms of the disease and BCR in patients with intermediate-risk prostate cancer. SII and PLR demonstrate an association with a locally advanced disease and the likelihood of BCR, with SII remaining an independent predictor. Nevertheless, the variability of threshold values according to literature data and the presence of cofactors limit their clinical use, which underlines the need for further prospective studies.