| Objectives:To explore the prognostic value of preoperative neutrophil to lymphocyte ratio(NLR)and lymphocyte to monocyte ratio(LMR)in patients with prostate cancer who had been treated with radical prostatectomy,and to screen independent hazard factors,which affected the prognosis of patients with prostate cancer,to establish a nomogram and evaluate it so as to offer a clinical reference for the treatment of prostate cancer.Methods:The objects of this study are patients with prostate cancer who underwent radical prostatectomy in urology department of our hospital from 2016 to 2019.Patients’ medical history,operation time,age,prostate size,the clinical peripheral blood test results,which include initial total prostate specific antigen,preoperative neutrophil value,alkaline phosphatase value,lymphocyte value and monocyte value,whole-body bone scan,hydronephrosis assessment,pathological results after transrectal ultrasound-guided prostate biopsy or transurethral resection prostate,pathological conditions after radical prostatectomy,which include T stage,primary grading area score of gleason,secondary grading area score of gleason,total score of gleason,grade and group of ISUP,tumor content,nerve assessment,capsule assessment,seminal vesicle assessment,vas deferens assessment from 204 patients were included in this retrospective study.Then we calculated NLR,prostate volume,LMR and prostate specific antigen density,and followed up the survival of patients and then calculated the overall survival.The cut-off value of NLR and LMR were calculated by maximum selection test,and the patients were divided into high groups of NLR and LMR,low groups of NLR and LMR.The statistical significance of various clinical indicators for the overall survival were analyzed by Kaplan-Meier curve,and the potential independent prognostic risk factors that affected the overall survival of patients with prostate cancer after radical prostatectomy were screened out by LASSO-COX regression analysis,and then the survival rate curve between different groups was constructed and the differences were compared by the log-rank test.At the same time,the risk prediction model was built according to the screening results and then visualized as a nomogram for evaluation.In this study,all statistical analyses of the relevant clinical data were performed by R 4.2.2 software and SPSS 27.0,when the differences were statistically significant,they were expressed as p<0.05.Results:1.The cut-off value of NLR and LMR was 2.25 and 4.44,and median survival time of patients with prostate cancer in the high NLR group and low NLR group was62 months and 71.5 months respectively,and the median survival time of patients with prostate cancer in the high LMR group and low LMR group was 70.5 months and 63 months respectively.The survival curves were statistically significant between the high NLR group and the low NLR group(p<0.0001)as well as the high LMR group and the low LMR group(p=0.00071).2.The OS followed by this study was 10 to 85 months,with an average of 57.3months.All cases’ 1,3,5-year cumulative OS rates were 99.0%,94.1%,and 84.4%.In univariate COX analysis,preoperative NLR,preoperative LMR,age,hydronephrosis,whole-body bone scan,seminal vesicular assessment,vas deferens assessment were significantly interrelated to the survival of patients with prostate cancer(p<0.05).3.The independent risk factors which affected the prognosis of patients with prostate cancer included preoperative NLR(HR=0.31,95%CI:0.12-0.78,p=0.013)and age(HR=1.15,95% confidence interval(CI):1.07-1.23,p<0.001)in multivariate analysis.4.In the nomogram based on the four clinical prognostic factors of preoperative NLR,age,hydronephrosis and bone metastasis,the C-index value was 0.796(95%CI:0.729-0.863).AUC were 0.896,0.873 and 0.807 respectively.The calibration diagram showed that the predicted calibration curve deviated from the standard curve in the nomogram model.The results of the DCA showed that the nomogram could produce a certain net clinical benefit,which offer a certain reference value for clinical treatment of prostate cancer.Conclusions:1.Preoperative low NLR is an independent risk factor affecting the prognosis of patients with prostate cancer undergoing radical prostatectomy.The lower the NLR level,the better the prognosis of patients.2.Cox univariate analysis showed that low LMR was a risk factor for the prognosis of patients with prostate cancer.The OS of low LMR group was lower than that of high LMR group.Multivariate analysis showed that the low LMR was not associated with the prognosis of the patients.3.The nomogram model based on the four factors of preoperative NLR,bone metastasis,age and hydronephrosis has a good predictive effect on the cumulative survival of patients with prostate cancer after radical prostatectomy. |
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