The preoperative neutrophil‐to‐lymphocyte ratio is not a marker of prostate cancer characteristics but is an independent predictor of biochemical recurrence in patients receiving radical prostatectomy

The neutrophil‐to‐lymphocyte ratio (NLR) has been reported to be a prognostic marker in prostate cancer. In this study, we assessed the association between preoperative NLR and the clinicopathological characteristics, biomolecular features and prognosis of patients with localized prostate cancer treated with radical prostatectomy. A total of 994 subjects were retrospectively enrolled, and the histological specimens of 210 patients were retrieved for constructing a tissue microarray. Immunohistochemistry was then performed to assess the expression of AR, ERG, PTEN, p‐AKT, Bcl‐2, Beclin‐1, Ki‐67, CD3, CD4, CD8, IFN‐γ and TNF‐α. No significant differences in the NLR distributions among clinicopathological variables were observed (P > 0.05) when the original NLR data were utilized. When we dichotomized the NLR value into the high‐NLR group (NLR ≥ 2) and low‐NLR group (NLR < 2), we found that the patients in the high‐NLR group had more prostate capsule invasion (P = 0.047). Additionally, no significant correlation was found between the NLR and infiltrating CD3(+) cells, the CD4/CD8 ratio, AR, ERG, PTEN, p‐AKT, Bcl‐2, Beclin‐1, Ki‐67, IFN‐γ or TNF‐α (P > 0.05). When we analyzed the data of patients without postoperative adjuvant hormone therapy or radiotherapy, univariate and multivariate survival analysis indicated that a high NLR was a predictor of better BCR‐free survival (P < 0.05). When analyzing the entire cohort, univariate survival analysis showed that the high‐NLR group had significantly poorer overall survival (P < 0.05). In conclusion, NLR cannot reflect prostate cancer characteristics or the local immune microenvironment, but a high NLR can serve as an independent predictor of better BCR.