MP35-03 RADIOGENOMICS OF CLEAR CELL RENAL CELL CARCINOMA: ASSOCIATIONS BETWEEN IMAGING, MOLECULAR ALTERATIONS AND PATHOLOGIC FEATURES

Abstract

INTRODUCTION AND OBJECTIVES: Aside from a biopsy, little information exists to guide a clinician when evaluating a patient with a solid renal mass. An elevated neutrophil-lymphocyte ratio (NLR) has been associated with adverse outcomes in clear cell renal cell carcinoma (ccRCC). However, its ability to distinguish aggressive RCC from benign, or indolent, renal tumors remains unknown. Therefore, we evaluate the association of NLR with pathologic outcomes at nephrectomy, including the ability to distinguish benign and malignant renal lesions. METHODS: From 1995-2008, 2402 patients underwent nephrectomy for localized renal masses. Of these, 2039 had an NLR collected 90 days prior to nephrectomy. Comparisons of NLR by tumor size, histologic subtype and nuclear grade were evaluated. RESULTS: Overall, benign renal masses had a significantly lower NLR than malignant renal tumors (median 2.92 vs. 3.12; p 1⁄40.037) with the greatest difference noted among renal lesions > 7 cm (median 2.79 vs 3.87; p 4 but 7 cm 1⁄4 3.09 and > 7 cm 1⁄4 3.95) and nuclear grade (G1 1⁄4 2.68, G2 1⁄4 2.87, G3 1⁄4 3.48 and G4 1⁄4 5.18) was associated with greater NLR (both p < 0.001). Finally, after stratifying ccRCC by tumor size, there was a continual increase in NLR with greater nuclear grade. CONCLUSIONS: An elevated NLR is associated with an increased risk of RCC at the time of nephrectomy as well as higher grade tumors and more aggressive histologic subtypes. Therefore, NLR appears to be a preoperative marker of aggressive RCC and may be useful in predicting malignancy and guiding management among patients with suspicious renal lesions.