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Does absolute neutrophil count predict adverse tumor grade in African American men with prostate cancer?

4616 Background: African Americans (AA) are known to have a phenomenon called "benign ethnic neutropenia (BEN)." This is well described in both the hematology and oncology literature and has been implicated as a source of disparity in cancer outcomes among AAs. Since AA are more likely to have pathological subtypes of prostate cancer, this investigation sought to determine if absolute neutrophil count (ANC) and therefore BEN is associated with adverse pathologic findings following radical prostatectomy (RP) within a cohort of AA men.


METHODS
The IRB-approved Columbia University urologic oncology database was retrospectively reviewed for all patients undergoing a RP who met inclusion criteria: AA race, pre-operative CBC with differential, and known final RP pathology. Neutropenia was defined as ANC level ≤1.5x109/L (1.5). Clinical and pathological variables were characterized within the AA cohort and linear regression analysis was performed. The primary outcome was adverse tumor grade, defined as Gleason score 8-10.


RESULTS
From 1994 to 2010, a total of 331 patients were identified. In this cohort, 18 (5.5%) patients with an ANC ≤1.5 were identified; the mean age was 59.9 ± 7.5 years and mean follow-up time was 48.9 ± 43.1 months. There were 273 (82.48%) patients with pathological Gleason score 2-7 and 58 (17.52%) patients with Gleason score 8-10 (p=0.045). Between the neutropenic and non-neutropenic cohorts, there was no significant difference in age, race, preoperative PSA, gleason score, node status, or tumor margins (p>0.05). The two groups differed with respect to pathologic gleason score: a higher percentage of neutropenic patients had Gleason score ≥8 than non-neutropenic patients (38.9% vs 16.3%; p=0.045). Univariable regression analysis showed that ANC ≤1.5 was associated with adverse tumor grade (HR 1.25, CI 1.05-1.50; p=0.014). Multivariable regression analysis showed that ANC ≤1.5 was an independent predictor of adverse tumor grade (HR 1.24, CI 1.02-1.51; p=0.030).


CONCLUSIONS
Neutropenia in AAs predicts adverse tumor grade at prostatectomy. Further studies are necessary to better understand the pathogenesis of prostate cancer, particularly as it relates to the African American population.