Can platelet distribution width lymphocyte ratio be a novel biomarker for predicting survival in metastatic renal cell cancer?

Abstract

Renal cell carcinoma (RCC) constitutes 3% of all malignant tumors in the adult patient population (1). As in other cancer processes, inflammation affects each step of tumor formation, including initiation of tumorigenesis, tumor promotion, and metastatic progression in RCC (2,3). It is widely accepted that C-reactive protein, fibrinogen, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio, and platelet-lymphocyte ratio (PLR) are markers of inflammation in both inflammatory diseases and malignant disease processes (2,3). Furthermore, a relatively high NLR was reported to be associated with an unfavorable prognosis and reduced overall survival in urological cancers (4,5). Platelets can secrete active metabolites and proteins and take a significant role in various processes such as inflammation, sepsis, and tissue regeneration (5). In addition, it is known that they can release growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta, and vascular endothelial growth factor (VEGF), which may all induce tumor angiogenesis and growth (6). In line with these findings, Tsujino et al. reported that platelet count could be an independent prognostic marker of overall survival and recurrence-free survival for patients with localized RCC (7). Additionally, Wang et al. stated that a high PLR value indicated an unfavorable prognosis in all urological cancers (8). Although several studies investigated the significance of hematological indices such as NLR and PLR in localized or metastatic RCC (mRCC), none focused on the platelet distribution width-lymphocyte ratio (PDWLR) (7,9,10). Therefore, this study aimed to analyze the prognostic significance of these platelet parameters in patients with mRCC.