https://doi.org/10.4081/aiua.2026.15630
Prognostic value of neutrophil-to-lymphocyte ratio in mCRPC patients treated with abiraterone, enzalutamide and docetaxel: a retrospective single-center study
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Published: 7 August 2026
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.
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CRediT authorship contribution
AMF: Study conception and design; acquisition of clinical data; data curation; data analysis and interpretation; drafting of the original manuscript; critical revision for important intellectual content; AR: Data curation; data analysis and interpretation; preparation of tables and figures; drafting of sections of the manuscript; VQ: Study conception and design; supervision; contribution to manuscript writing and editing; critical revision for important intellectual content; RJ: Data curation; data analysis and interpretation; preparation of tables and figures; drafting of sections of the manuscript; ETS: Data curation; data analysis and interpretation; critical revision of the manuscript; PN: Study conception and design; supervision; contribution to manuscript writing and editing; critical revision for important intellectual content; AF: Study conception and design; supervision; critical revision for important intellectual content; final approval of the manuscript.
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to ethical and legal restrictions imposed by the hospital's data protection policies, but de-identified data may be available from the corresponding author upon reasonable request and with appropriate institutional approvals.
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