Predictive Value of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR) and Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) for Biochemical Recurrence After Radical Prostatectomy.

BACKGROUND We investigated the potential of the preoperative neutrophil-to-lymphocyte ratio (NLR) and soluble urokinase-type plasminogen activator receptor (suPAR) as predictive biomarkers for biochemical recurrence (BCR) following radical prostatectomy in prostate cancer (PCa). By examining these markers individually and in combination, we aimed to enhance risk stratification and improve postoperative management. MATERIAL AND METHODS A retrospective cohort of 245 patients with PCa who underwent laparoscopic radical prostatectomy were stratified into non-BCR (n=183) and BCR (n=62) groups based on a 2-year follow-up. We collected comprehensive clinical and pathological data, calculated preoperative NLR, and measured serum suPAR using ELISA. Cox regression analysis identified independent risk factors for BCR, while ROC curves evaluated the predictive power of NLR, suPAR, and their combination. Kaplan-Meier survival analysis assessed BCR risk associated with varying levels of these biomarkers. RESULTS Preoperative NLR and suPAR levels were significantly higher in the BCR group. Multivariate Cox regression identified several independent risk factors for BCR, including preoperative PSA ≥20 ng/mL, pathological T3-T4 stage, positive surgical margins, and elevated NLR and suPAR levels. ROC analysis showed NLR and suPAR combined (AUC: 0.943, 95% CI: 0.911-0.975) significantly outperformed the predictive accuracy of each marker alone, with standalone AUCs of 0.873 for NLR and 0.881 for suPAR. CONCLUSIONS Elevated preoperative NLR and suPAR are strongly associated with increased BCR risk after radical prostatectomy in patients with PCa. Combined assessment of these biomarkers offers a superior predictive tool, facilitating personalized risk stratification and potentially guiding tailored postoperative management strategies in PCa care.