Cancer Causes & Control

, Volume 29, Issue 6, pp 581–588 | Cite as

Neutrophil, lymphocyte and platelet counts, and risk of prostate cancer outcomes in white and black men: results from the SEARCH database

  • Adriana C. Vidal
  • Lauren E. Howard
  • Amanda de Hoedt
  • Matthew R. Cooperberg
  • Christopher J. Kane
  • William J. Aronson
  • Martha K. Terris
  • Christopher L. Amling
  • Emanuela Taioli
  • Jay H. Fowke
  • Stephen J. Freedland
Original paper



Systemic inflammation, as measured by C-reactive protein, has been linked with poor prostate cancer (PC) outcomes, predominantly in white men. Whether other immune measures like white blood cell counts are correlated with PC progression and whether results vary by race is unknown. We examined whether complete blood count (CBC) parameters were associated with PC outcomes and whether these associations varied by race.


Analyses include 1,826 radical prostatectomy patients from six VA hospitals followed through medical record review for biochemical recurrence (BCR). Secondary outcomes included castration-resistant PC (CRPC), metastasis, all-cause mortality (ACM), and PC-specific mortality (PCSM). Cox-proportional hazards were used to assess the associations between pre-operative neutrophils, lymphocytes, platelets, neutrophil–lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) with each outcome. We used a Bonferroni-corrected p-value of 0.05/5 = 0.01 as the threshold for statistical significance.


Of 1,826 men, 794 (43%) were black and 1,032 (57%) white. Neutrophil count (p < 0.001), NLR (p < 0.001), and PLR (p < 0.001) were significantly lower, while lymphocyte count (p < 0.001) was significantly higher in black versus white men. After adjusting for clinicopathological features, no CBC measures were significantly associated with BCR. There were no interactions between CBC and race in predicting BCR. Similarly, no CBC values were significantly associated with CRPC, metastases, or PCSM either among all men or when stratified by race. However, higher neutrophil count was associated with higher ACM risk in white men (p = 0.004).


Pre-operative CBC measures were not associated with PC outcomes in black or white men undergoing radical prostatectomy, except for neutrophils-positive association with risk of ACM in white men. Whether circulating immune cell markers provide insight to the pathophysiology of PC progression or adverse treatment outcomes requires further study.


CBC Prostate cancer Radical prostatectomy 



Supported by National Institutes of Health; Grant numbers: K24 CA160653, NIH R01CA100938 (WJA), NIH Specialized Programs of Research Excellence Grant P50 CA92131-01A1 (WJA).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10552_2018_1031_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 KB)


  1. 1.
    Nelson WG, De Marzo AM, Isaacs WB (2003) Prostate cancer. N Engl J Med 349:366–381CrossRefPubMedGoogle Scholar
  2. 2.
    Vidal AC, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL, Freedland SJ (2015) Aspirin, NSAIDs, and risk of prostate cancer: results from the REDUCE study. Clin Cancer Res 21:756–762CrossRefPubMedGoogle Scholar
  3. 3.
    Liu Y, Chen JQ, Xie L, Wang J, Li T, He Y et al (2014) Effect of aspirin and other non-steroidal anti-inflammatory drugs on prostate cancer incidence and mortality: a systematic review and meta-analysis. BMC Med 12:55CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Moreira DM, Nickel JC, Gerber L, Muller RL, Andriole GL, Castro-Santamaria R et al (2014) Baseline prostate inflammation is associated with a reduced risk of prostate cancer in men undergoing repeat prostate biopsy: results from the REDUCE study. Cancer 120:190–196CrossRefPubMedGoogle Scholar
  5. 5.
    Guo YZ, Pan L, Du CJ, Ren DQ, Xie XM (2013) Association between C-reactive protein and risk of cancer: a meta-analysis of prospective cohort studies. APJCP 14:243–248PubMedGoogle Scholar
  6. 6.
    Graff JN, Beer TM, Liu B, Sonpavde G, Taioli E (2015) Pooled analysis of C-reactive protein levels and mortality in prostate cancer patients. Clinical Genitourin Cancer 13:e217–221CrossRefGoogle Scholar
  7. 7.
    Gu X, Gao X, Li X, Qi X, Ma M, Qin S et al (2016) Prognostic significance of neutrophil-to-lymphocyte ratio in prostate cancer: evidence from 16,266 patients. Sci Rep 6:22089CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Azab B, Camacho-Rivera M, Taioli E (2014) Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PloS ONE 9:e112361CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Vidal AC, Chen Z, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL et al. (2016) Racial differences in prostate inflammation: results from the REDUCE study. Oncotarget 8:71393PubMedPubMedCentralGoogle Scholar
  10. 10.
    Wallace TA, Prueitt RL, Yi M, Howe TM, Gillespie JW, Yfantis HG et al (2008) Tumor immunobiological differences in prostate cancer between African-American and European-American men. Cancer Res 68:927–936CrossRefPubMedGoogle Scholar
  11. 11.
    Powell IJ, Dyson G, Land S, Ruterbusch J, Bock CH, Lenk S et al. (2013) Genes associated with prostate cancer are differentially expressed in African American and European American men. Cancer Epidemiol Prev Biomark 22:891–897CrossRefGoogle Scholar
  12. 12.
    Vidal AC, Howard LE, Sun SX, Cooperberg MR, Kane CJ, Aronson WJ et al (2017) Obesity and prostate cancer-specific mortality after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Prostate Cancer Prostatic Dis 20:72–78CrossRefPubMedGoogle Scholar
  13. 13.
    Sadeghi N, Badalato GM, Hruby G, Grann V, McKiernan JM (2012) Does absolute neutrophil count predict high tumor grade in African-American men with prostate cancer? Prostate 72:386–391CrossRefPubMedGoogle Scholar
  14. 14.
    Sionov RV, Fridlender ZG, Granot Z (2015) The multifaceted roles neutrophils play in the tumor microenvironment. Cancer Microenviron 8:125–158CrossRefPubMedGoogle Scholar
  15. 15.
    Haddy TB, Rana SR, Castro O (1999) Benign ethnic neutropenia: what is a normal absolute neutrophil count? J Lab Clin Med 133:15–22CrossRefPubMedGoogle Scholar
  16. 16.
    Reich D, Nalls MA, Kao WH, Akylbekova EL, Tandon A, Patterson N et al (2009) Reduced neutrophil count in people of African descent is due to a regulatory variant in the Duffy antigen receptor for chemokines gene. PLoS Genet 5:e1000360CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Thobakgale CF, Ndung’u T (2014) Neutrophil counts in persons of African origin. Curr Opin Hematol 21:50–57CrossRefPubMedGoogle Scholar
  18. 18.
    Kulkarni H, Marconi VC, He W, Landrum ML, Okulicz JF, Delmar J et al (2009) The Duffy-null state is associated with a survival advantage in leukopenic HIV-infected persons of African ancestry. Blood 114:2783–2792CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Heffernan KS, Jae SY, Vieira VJ, Iwamoto GA, Wilund KR, Woods JA et al (2009) C-reactive protein and cardiac vagal activity following resistance exercise training in young African-American and white men. Am J Physiol Regul Integr Comp Physiol 296:R1098–R105CrossRefGoogle Scholar
  20. 20.
    Kwagyan J, Retta TM, Ketete M, Bettencourt CN, Maqbool AR, Xu S et al (2015) Obesity and cardiovascular diseases in a high-risk population: evidence-based approach to CHD risk reduction. Ethn Dis 25:208–213PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Adriana C. Vidal
    • 1
  • Lauren E. Howard
    • 2
    • 3
  • Amanda de Hoedt
    • 3
  • Matthew R. Cooperberg
    • 4
  • Christopher J. Kane
    • 5
  • William J. Aronson
    • 6
    • 7
  • Martha K. Terris
    • 8
    • 9
  • Christopher L. Amling
    • 10
  • Emanuela Taioli
    • 11
  • Jay H. Fowke
    • 12
  • Stephen J. Freedland
    • 1
    • 3
    • 13
  1. 1.Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamUSA
  3. 3.Surgery SectionDurham VA Medical CenterDurhamUSA
  4. 4.Department of UrologyUCSF Helen Diller Family Comprehensive Cancer CenterSan FranciscoUSA
  5. 5.Urology DepartmentUniversity of California San Diego Health SystemSan DiegoUSA
  6. 6.Urology Section, Department of SurgeryVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesUSA
  7. 7.Department of UrologyUCLA School of MedicineLos AngelesUSA
  8. 8.Section of UrologyVeterans Affairs Medical CenterAugustaUSA
  9. 9.Department of Surgery, Section of UrologyMedical College of GeorgiaAugustaUSA
  10. 10.Department of UrologyOregon Health and Science University HospitalPortlandUSA
  11. 11.Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  12. 12.Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  13. 13.Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations