Prognostic significance of preoperative and follow-up neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma

• Published in: Investigative and clinical urology Vol. 60; no. 1; pp. 14 - 20
• Main Authors: Kim, Tae Woo, Lee, Jung Hwan, Shim, Kang Hee, Choo, Seol Ho, Choi, Jong Bo, Ahn, Hyun Soo, Kim, Se Joong, Kim, Sun Il
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Urological Association 01.01.2019; Korean Urological Association; 대한비뇨의학회
• Subjects: Adult; Aged; Blood Platelets - pathology; Carcinoma renal cell; Carcinoma, Renal Cell - blood; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Female; Follow-Up Studies; Humans; Inflammation; Kidney Neoplasms - blood; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Leukocyte Count; Lymphocyte Count; Lymphocytes - pathology; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Nephrectomy; Neutrophils - pathology; Original; Platelet Count; Preoperative Period; Prognosis; renal cell; Retrospective Studies; 비뇨기과학; Carcinoma, renal cell; Inflammation; Prognosis
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.2019.60.1.14

To evaluate the significance of preoperative and follow-up neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for recurrence in patients with non-metastatic clear cell renal cell carcinoma (NMCCRCC). We retrospectively reviewed the medical records of 309 patients with NMCCRCC who underwent radical or partial nephrectomy. The prognostic significance of various clinicopathological variables, preoperative NLR (pNLR) and PLR (pPLR), and NLR and PLR at recurrence or quasi-recurrence (rNLR and rPLR) for recurrence-free survival (RFS) was analyzed. At mean follow-up of 93 months, 44 patients (14.2%) developed recurrence. In the univariate analysis, clinical presentation, tumor size, pathologic tumor stage, Fuhrman grade, pNLR, pPLR and rNLR were significant prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as continuous variables, tumor size, pathologic tumor stage and pPLR were independent prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as dichotomous variables, tumor size, pathologic tumor stage, Fuhrman grade and pNLR ≥1.7 were independent prognostic factors for RFS. In multivariate analyses using rNLR and rPLR, only tumor size and pathologic tumor stage were independent prognostic factors for RFS. In a subset of patients with recurrence or at least 42 months follow-up without recurrence, rNLR ≥1.9 was significantly associated with worse RFS, albeit without independent significance. pNLR and pPLR are independent prognostic factors for RFS in patients with NMCCRCC. We propose that postoperative follow-up NLR of 1.9 and higher with one or more adverse clinicopathological factors should prompt radiologic evaluation for possible metastasis.