Abstract
Background. The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in nonmetastatic renal cell carcinoma (non-mRCC) is controversial, although NLR has been established as a prognostic factor in several cancers. The objective of our study was to assess the prognostic significance of preoperative NLR in non-mRCC, based on a large, multicenter cohort analysis. Methods. Totally, 1,284 non-mRCC patients undergoing surgery were enrolled from six institutions between 2000 and 2014. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were calculated, and the prognostic significance of NLR was evaluated. Results. Patients with higher NLR had larger tumors (p < 0.001), higher T stage (p < 0.001), worse Eastern Cooperative Oncology Group performance status (p < 0.001), worse symptoms (p = 0.003), sarcomatoid differentiation (p = 0.004), and tumor necrosis (p < 0.001). The 5-year RFS and CSS rates were significantly lower in patients with high NLR than in those with low NLR (each p < 0.001). Multivariate analysis identified NLR to be an independent predictor of RFS and CSS (each p < 0.05). Moreover, predictive accuracy of multivariate models for RFS and CSS increased by 2.2% and 4.2%, respectively, with NLR inclusion. Conclusions. Higher NLR was associated with worse clinical behavior of non-mRCC. Also, NLR was a significant prognostic factor of both RFS and CSS.
Highlights
Renal cell carcinoma (RCC) accounts for 3-4% of all adult malignancies, and its incidence rate has been steadily increasing worldwide [1]
Patients with complete absolute neutrophil count (ANC) and absolute lymphocyte count (ALC) data within the 2 weeks before surgery were included in the study
neutrophil-to-lymphocyte ratio (NLR) was identified to be a significant prognostic factor of both Recurrence-free survival (RFS) and cancer-specific survival (CSS) in patients with nonmetastatic renal cell carcinoma (nonmRCC), even when the models were adjusted for other wellknown prognostic factors
Summary
Renal cell carcinoma (RCC) accounts for 3-4% of all adult malignancies, and its incidence rate has been steadily increasing worldwide [1]. As inflammation is accessible, can be measured reliably, and can be incorporated into the tumor staging system [4], its use as a prognostic factor seems promising. The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in nonmetastatic renal cell carcinoma (nonmRCC) is controversial, NLR has been established as a prognostic factor in several cancers. The objective of our study was to assess the prognostic significance of preoperative NLR in non-mRCC, based on a large, multicenter cohort analysis. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were calculated, and the prognostic significance of NLR was evaluated. Predictive accuracy of multivariate models for RFS and CSS increased by 2.2% and 4.2%, respectively, with NLR inclusion. NLR was a significant prognostic factor of both RFS and CSS
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