Can we Avoid the Unnecessary Loss of nephrons in the Management of Small Solid Renal Masses? Additional Clinical Parameters to Predict Benign-malign Distinction.

Abstract

Objectives:We aimed to investigate the predictive value of additional parameters for distinguishing benign-malign tumors and to prevent the loss of nephrons in small (≤4 cm) solid renal masses.Methods:The data of 56 patients underwent partial or radical nephrectomy between September 2009 and December 2017 due to diagnosis of localized renal cell carcinoma were retrospectively analyzed. Demographic datas, histopathological tumor types, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV), the Framingham risk score and its components, postoperative follow-up results were recorded. Patients were divided into two groups as benign and malign.Results:Among 56 patients with a median age of 60 (min: 35-max: 74) years, 13 patients had benign and 43 patients had malign pathologies. MLR (p=0.011), NLR (p=0.032), PLR (p=0.006), MPV (p=0.025), eGFR (p=0.019) and the Framingham score (p=0.008) were significantly higher in malign group. Among the components constituting the Framingham score, only presence of smoking (p=0.032), presence of hypertension (p=0.041) and total cholesterol values (p=0.021) were significantly higher. In multivariate analysis, NLR>2.02 (OR: 7.184, p=0.037), PLR>109.65 (OR: 12.692, p=0.002), MPV>3.44 (OR: 10.543, p=0.046) and Framingham score >10.5 (OR: 12.287, p=0.007) were found as predictive factors for distinguishing small solid renal masses concerning malignancy.Conclusion:We think that NLR, PLR, MPV and the Framingham scores may be used in the clinical evaluation of small solid renal masses. In this way, we may prevent the unnecessary loss of nephrons in benign masses with suspicion of malignancy.