Neutrophil, platelets, and eosinophil to lymphocyte ratios predict gleason score upgrading in low-risk prostate cancer patients

Matteo Ferro, Gennaro Musi, Alessandro Serino, Gabriele Cozzi, Francesco Alessandro Mistretta, Beatrice Costa, Roberto Bianchi, Giovanni Cordima, Stefano Luzzago, Ettore Di Trapani, Elena Tagliabue, Mihai Dorin Vartolomei, Daniela Terracciano, Maria C. Cassatella, Michela Salvatici, Andrea Conti, Maria Teresa Sandri, Antonio Cioffi, Matteo Turetti, Michele CatellaniDanilo Bottero, Deliu Victor Matei, Vincenzo Mirone, Ottavio De Cobelli

Research output: Contribution to journalReview articlepeer-review


Background: Several biochemical and clinical markers have been proposed for selecting patients for active surveillance (AS). However, some of these are expensive and not easily accessible. Moreover, currently about 30% of patients on AS harbor aggressive disease. Hence, there is an urgent need for other tools to accurately identify patients with low-risk prostate cancer (PCa). Patients: We retrospectively reviewed the medical records of 260 patients who underwent radical prostatectomy and were eligible for AS according to the following criteria: Clinical stage T2a or less, prostate-specific antigen level < 10 ng/mL, 2 or fewer cores involved with cancer, Gleason score (GS) ≤6 grade, and prostate-specific antigen density < 0.2 ng/mL/cc. Methods: Univariate and multivariate analyses were performed to evaluate the association of patient and tumor characteristics with reclassification, defined as upstaged (pathological stage >pT2) and upgraded (GS ≥7) disease. A base model (age, prostate-specific antigen, prostate volume, and clinical stage) was compared with models considering neutrophil to lymphocyte ratio (NLR) or platelets to lymphocyte ratio (PLR), monocyte to lymphocyte (MLR), and eosinophil to lymphocyte ratio (ELR). OR and 95% CI were calculated. Finally, a decision curve analysis was performed. Results: Univariate and multivariate analyses showed that NLR, PLR, and ELR upgrading were significantly associated with upgrading (ORs ranging from 2.13 to 4.13), but not with upstaging except for MLR in multivariate analysis, showing a protective effect. Conclusion: Our results showed that NLR, PLR, and ELR are predictors of Gleason upgrading. Therefore, these inexpensive and easily available tests might be useful in the assessment of low-risk PCa, when considering patients for AS.

Original languageEnglish
Pages (from-to)96-101
Number of pages6
JournalUrologia Internationalis
Issue number1
Publication statusPublished - Jan 1 2019


  • Eosinophil to lymphocyte
  • Neutrophil to lymphocyte ratio
  • Platelets to lymphocyte ratio
  • Prostate cancer

ASJC Scopus subject areas

  • Urology


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