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Sources of Funding: none

Introduction

Elevated neutrophil-to-lymphocyte ratio (NLR) has been reported to be a poor prognostic indicator in several malignancies and associated with response to immune checkpoint inhibitors; however the association with testicular cancer has not been evaluated. We explore the association between NLR on staging of testicular germ cell tumors (TGCT).

Methods

Retrospective review of institutional testicular tumor database from 2010-2016. Patients with non-TGCT were excluded. Patients were categorized as localized or non-localized based on the presence of retroperitoneal or distant metastasis or elevated serum tumor markers following orchiectomy. Pre-and post-orchiectomy mean serum NLR and was calculated for patients and correlated with disease state. NLR > 4 was assessed separately based on previously reported correlation of this cut-point with prognosis in other malignancies. ROC analysis was used to determine accuracy of the NLR to distinguish patients presenting with clinically non-localized disease

Results

159 pts with TGCT were identified for analysis: seminoma (n=59), NSGCT (n=97), ITGCN (n=2), unknown (n=1). Pre- and post-orchiectomy NLR was available for 61 and 56 patients, respectively. Mean NLR was significantly higher for patients with non-localized TGCT (Table). ROC analysis (Figure) demonstrated that pre-orchiectomy NLR was associated with the presence of non-localized disease (AUC 0.770, p<0.001), while post-orchiectomy NLR trended toward significance (AUC 0.659, p=0.063) as a factor associated with the presence of non-localized disease. Additionally, mean pre-orchiectomy NLR demonstrated a dose-response relationship with IGCCCG risk grouping for metastatic TGCT: good risk - NLR 4.6±4.0, intermediate risk - NLR 5.7±3.4, poor risk - NLR 13.2±9.8, (p=0.013)

Conclusions

NLR appears to be predictive of non-localized TGCT. Application of NLR may be useful as a predictive biomarker in a number of settings in which presence or degree of non-localized disease is in question e.g. prior to post-chemotherapy RPLND. Further validation is required.

Funding

none