Prognostic value of neutrophil-to-lymphocyte ratio in mCRPC patients treated with abiraterone, enzalutamide and docetaxel: a retrospective single-center study.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic biomarker in several solid tumors, including metastatic castration-resistant prostate cancer (mCRPC). However, its clinical utility remains controversial, particularly across different treatment modalities. AIM: To evaluate the prognostic value of baseline NLR in patients with mCRPC treated with abiraterone, enzalutamide, or docetaxel, and to assess its association with survival outcomes and PSA response. METHODS: We conducted a retrospective, single-center study including patients with mCRPC treated between December 2019 and January 2022. Patients were stratified according to a prespecified NLR cut-off of 4. The primary endpoint was overall survival (OS), and the secondary endpoint was PSA progressionfree survival (PSA-PFS). PSA response at 6 months was also evaluated. Survival outcomes were estimated using the Kaplan-Meier method, and the association between NLR and OS was assessed using univariable Cox regression. RESULTS: A total of 186 patients were included. Median age was 77.0 years, and median baseline PSA was 31.1 ng/mL. Patients with NLR ≥ 4 (26.3%) had significantly worse OS compared to those with NLR < 4, with median OS of 16 versus 30 months. NLR ≥ 4 was associated with an increased risk of death (HR 2.05, 95% CI 1.24-3.39, p = 0.005). When analyzed as a continuous variable, higher NLR was also associated with shorter OS (HR 1.12, 95% CI 1.05-1.20, p < 0.001). Patients with higher NLR showed shorter PSA-PFS (8.0 vs 10.5 months). However, no significant differences were observed in PSA response at 6 months, including PSA50 and PSA90 rates. CONCLUSIONS: Elevated NLR is associated with worse overall survival and earlier disease progression in patients with mCRPC treated with contemporary systemic therapies. While NLR does not appear to predict early biochemical response, it may reflect the durability of treatment benefit. These findings support NLR as a simple and clinically useful prognostic biomarker in mCRPC.