• Mahmut Taha Olcucu, Kaan Karamik, Kayhan Yilmaz, Cagatay Ozsoy, Yasin Aktas, and Mutlu Ates.
• Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Turkey.
• J Coll Physicians Surg Pak. 2020 Sep 1; 30 (9): 921-927.

ObjectiveTo evaluate the importance of preoperative neutrophil-to-lymphocyte ratio (NLR),  lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-monocyte ratio (NMR) in prostate cancer patients, who underwent robot-assisted radical prostatectomy (RARP).Study DesignObservational study.Place And Duration Of StudyUrology Department, Antalya Training and Research Hospital, Turkey, between March 2015 and September 2019.MethodologyFour hundred and fifty-four patients underwent RARP were scanned. Clinical characteristics and pathological features of patients were recorded. Patients were excluded, if they had persistent PSA; a history of any autoimmune or inflammatory disease; anti-inflammatory agents use; blood transfusion within 3 months; or a follow-up time shorter than 3 months. Systemic inflammation markers were calculated and correlated with patients' data and biochemical recurrence (BCR). Biochemical recurrence was defined as two repetitive measurements of PSA levels ≥0.2 ng/mL at 3  months after the radical prostatectomy. Mann-Whitney U-test, Fisher's exact test, and Pearson Chi-square test, ROC curve, Kaplan-Meier survival analyses, and Cox proportional hazard regression model were used as statistical methods.Results  Four hundred and two patients were eligible. The median age at RP was 65.5 (61-69) years and median PSA of the patients was 8.3 (5.76-12.61)  ng/ml. Median NLR, LMR, PLR, and NMR were 2 (1.55-2.61), 3.86 (3.14-5), 105.69 (85-134.29), 7.82 (6.25-9.71); and  optimal cut-off values were 2.33, 3.75, 106.6, and 8.75, respectively. Low LMR was found as  an important predictor of biochemical recurrence (hazard ratio, HR=1.769, 95% confidence interval, CI=1.091 - 2.868, p=0.021). A significant association was found between lower LMR and decreased BCR -free survival (p <0.001).ConclusionPretreatment low LMR might be a simple and inexpensive index, which reflects the host systemic immunity and can predict independently BCR after RARP. Key Words: Biochemical recurrence, Lymphocyte-to-monocyte ratio, Neutrophil-to-lymphocyte ratio, Neutrophil-to-monocyte ratio, Platelet-to-lymphocyte ratio, Prostate cancer.

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