World Journal of Urology

, Volume 33, Issue 11, pp 1661–1667 | Cite as

Validation of the neutrophil-to-lymphocyte ratio as a prognostic factor in a cohort of European prostate cancer patients

  • Tanja LangsenlehnerEmail author
  • Eva-Maria Thurner
  • Sabine Krenn-Pilko
  • Uwe Langsenlehner
  • Tatjana Stojakovic
  • Armin Gerger
  • Martin Pichler
Original Article



Recent studies have expanded the concept that the systemic inflammatory response has an important role in the progression of several solid tumors. The neutrophil-to-lymphocyte ratio (NLR), an easily determinable marker of systemic inflammation, has been associated with clinical outcome in various cancer entities. In the present study, we validated the prognostic relevance of an elevated NLR in a cohort of European prostate cancer patients.


Data from 415 consecutive prostate cancer patients treated with 3D conformal radiotherapy at a single tertiary academic center from 1999 to 2007 were included in this retrospective study. Clinical progression-free survival (PFS), distant metastases-free survival (DMFS), and overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the prognostic relevance, univariate and multivariate Cox regression models were performed for each end point.


Based on previously published studies, an NLR ≥ 5 was selected as cutoff value for external validation. Multivariate analysis identified an increased NLR as an independent prognostic factor for clinical PFS [hazard ratio (HR) 3.09, 95 % CI 1.64–5.82, p < 0.001], DMFS (HR 3.51, 95 % CI 1.80–6.85, p < 0.001), and OS (HR 2.16, 95 % CI 1.17–3.99, p = 0.013).


The NLR seems to represent an independent prognostic marker and should be considered for future individual risk assessment in patients with prostate cancer.


Prostate cancer Prognosis Inflammation Neutrophil-to-lymphocyte ratio 


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was complied with the Declaration of Helsinki and has been approved by the local Ethical Committee (EK 27-032 ex 14/15). As this is a retrospective nonintervention study, the institutional review board waived the need for written informed consent from the participants.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tanja Langsenlehner
    • 1
    Email author
  • Eva-Maria Thurner
    • 1
  • Sabine Krenn-Pilko
    • 1
  • Uwe Langsenlehner
    • 2
  • Tatjana Stojakovic
    • 3
  • Armin Gerger
    • 4
  • Martin Pichler
    • 4
  1. 1.Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center GrazMedical University of GrazGrazAustria
  2. 2.Division of Internal MedicineOutpatient Department GrazGrazAustria
  3. 3.Clinical Institute of Medical and Chemical Laboratory Diagnostics, Comprehensive Cancer Center GrazMedical University of GrazGrazAustria
  4. 4.Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer CenterMedical University of GrazGrazAustria

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