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CUAJ Letters is an open forum to
discuss papers published in CUAJ.
The neutrophil-to-lymphocyte ratio in
clinical practice
Letters are published at the discretion
of the editors, and are subject to
abridgement and editing for style and
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Editor at journal@cua.org.
1
2
Ali Gürağ
aç, MD; Zafer Demirer, MD
1
2
Tatvan Military Hospital, Department of Urology, Bitlis, Turkey; Eskisehir Military Hospital, Department of Urology, Eskisehir, Turkey
Cite as: Can Urol Assoc J 2016;10(3-4):141-2. http://dx.doi.
org/10.5489/cuaj.3587
trophils and lymphocytes are thought
to be significant in tumour immunol-
ogy and inflammation. Inflammation
References
1
.
Gokce MI, Hamidi N, Suer E, et al. Evaluation of neutrophil-to-
lymphocyte ratio prior to prostate biopsy to predict biopsy histo-
logy: Results of 1836 patients. Can Urol Assoc J 2015;9:E761-5.
http://dx.doi.org/10.5489/cuaj.3091
e read with great interest
the article, “Evaluation of
neutrophil-to-lymphocyte
plays a significant role in the prolife-
ration, angiogenesis, and metastasis
of cancer cells and is important in
the development and progression of
W
2
.
Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and
simple parameter of systemic inflammation and stress in critically
ill. Bratisl LekListy 2001;102:5-14.
ratio prior to prostate biopsy to pre-
dict biopsy histology: Results of 1836
2
,3
the disease. Even when white blood
cell count is in normal range, NLR has
been demonstrated to play a predictive
role in the prognosis of chronic and
1
3. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and
cancer. Cell 2010;140:883-99. http://dx.doi.org/10.1016/j.
cell.2010.01.025
patients,” by Gokce et al. Investigators
aimed to evaluate the role of neutrop-
hil-to-lymphocyte ratio (NLR) prior to
prostate biopsy to predict biopsy his-
tology and Gleason score in patients
with prostate cancer.
4
.
Ozcan C, Telli O, Ozturk E, et al. The prognostic significance of
preoperative leukocytosis and neutrophil-to-lymphocyte ratio in
patients who underwent radical cystectomy for bladder cancer. Can
Urol Assoc J 2015;9:E789-94. http://dx.doi.org/10.5489/
cuaj.3061
2
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acute inflammatory processes.
A recent meta-analysis study conc-
ludes that a high NLR is an independent
factor associated with poorer overall
survival in many solid tumours (colore-
ctal, hepatocellular, gastroesophageal,
ovarian, and pancreatic carcinoma).
This marker may be associated with
renal or hepatic dysfunction, diabetes
mellitus, abnormal thyroid function,
hypertension, metabolic syndrom,
hematological malignancies, known
malignancy, preceding history of local
or systemic infection, inflammatory
diseases, and any use of medication
connected to inflammatory status of
The mean NLR of the prostate can-
cer group was significantly higher than
that of the benign prostatic hypertrop-
hy (BPH) group (p=0.002). The mean
NLR of the prostatitis group was higher
than that of both the prostate cancer
and BPH groups (p=0.0001). The mean
NLR of the Gleason score (GS) 8–10
group was higher than that of the GS 7
and GS 5‒6 groups. The authors conc-
lude that NLR was found to vary with
regard to histology of prostate biopsy
and higher GS was associated with
higher NLR in patients with prostate
cancer.
5
6
.
.
Maeda Y, Kawahara T, Kumano Y, et al. The neutrophil-to-lymp-
hocyte ratio before repeat prostate needle biopsy for predicting
prostate cancer. Urol Int 2015 Dec 16. [Epub ahead of print].
http://dx.doi.org/10.1159/000442895
Kaynar M, Yıldırım ME, Badem H, et al. Bladder cancer invasion
predictability based on preoperative neutrophil–lymphocyte ratio.
Tumour Biol 2014;35:6601-5. http://dx.doi.org/10.1007/
s13277-014-1889-x
7. Demirer Z, Uslu AU. More work needed in examining the relations-
hip between mean platelet volume and inflammation in varicocele
pathophysiology. Can Urol Assoc J 2015;9:E639. http://dx.doi.
org/10.5489/cuaj.3114
8
.
Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role
of neutrophil-to-lymphocyte ratio in solid tumours: A systematic
review and meta-analysis. J Natl Cancer Inst 2014;106:dju124.
http://dx.doi.org/10.1093/jnci/dju124
9
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patients.
The authors should have
9
.
Balta S, Demirer Z, Aparci M, et al. The relation between lymp-
hocyte-monocyte ratio and renal cell carcinoma. Urol Oncol
mentioned these factors.
Complete blood count is a inex-
pensive, comparatively routine, and
practical laboratory test that gives
us important information about the
patient’s formed blood contents.
Routine peripheral blood counts may
be useful in diagnosis and prognosis
of many disorders, including prostatic
diseases.2
In conclusion, we strongly believe
the findings obtained from the current
study will lead to further studies exa-
mining the evaluation of NLR prior to
prostate biopsy to predict biopsy his-
tology.
2
015;33:421.
1
1
1
0. Demirer Z, Uslu AU. Predictive value of neutrophil-lymphocyte ratio
in non-muscle-invasive bladder cancer. Urol Oncol 2016;34:1-2.
http://dx.doi.org/10.1016/j.urolonc.2015.09.006
1. Balta S, Demırer Z, Aparci M, et al. The lymphocyte-monocyte
ratio in clinical practice. J Clin Pathol 2016;69:88-9. http://
dx.doi.org/10.1136/jclinpath-2015-203233
2. Demirer Z, Uslu AU, Balta S. Letter to the editor: Predictive value
of the neutrophil-lymphocyte ratio and mean platelet volume in
testicular torsion. Korean J Urol 2015;56:601-2.
Competıng ınterests: The authors declare no competing financial
or personal interests.
-12
NLR is measured by dividing the
number of neutrophils by the number
of lymphocytes. NLR may be an indi-
cator of systemic inflammation, as neu-
Correspondence: Dr. Zafer Demirer, Eskisehir Military Hospital,
Department of Urology, Eskisehir, Turkey; zaferdemirer@mynet.com
CUAJ • March-April 2016 • Volume 10, Issues 3-4
141
