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

Abstract

Introduction & Objectives: This study was performed to evaluate the significance of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as a predictive factor for recurrence in patients with non-metastatic clear cell renal cell carcinoma (RCC).

Material & Methods: We retrospectively reviewed the medical records of 341 patients (232 men and 109 women, mean age of 54.9 years) with non-metastatic clear cell RCC who underwent radical or partial nephrectomy between March 1995 and July 2012. Patients longer than 12 months follow-up were included. The prognostic significance of various clinicopathological variables for recurrence-free survival and cancer specific-free survival was analyzed by using univariate and multivariate analysis.

Results: The median follow-up duration was 48 months (mean, 54.1; range, 12-215 months). Of the total 341 patients, 37 patients (10.9%) developed metastases and 14 patients (4.1%) died of renal cell carcinoma among 21 patients who died during the follow-up period. Preoperative NLR was significantly correlated with symptom presentation (p=0.008), tumor size (p=0.022), T stage (p=0.004), neutrophil count (p<0.001), lymphocyte count (p<0.001), recurrence at follow-up (p=0.006). Preoperative PLR was significantly correlated with symptom presentation (p<0.001), lymphocyte count (p<0.001), recurrence at follow-up (p=0.002). In the univariate analysis, clinical presentation, tumor size, T stage, Fuhrman grade, preoperative hemoglobin, neutrophil count, NLR, PLR were significant prognostic factors for recurrence-free survival. The 5-year recurrence-free survival rate of patients with a higher preoperative NLR (≥2.5) was significantly lower than that of patients with a lower preoperative NLR (<2.5) (86.5% vs. 96.7%, p=0.006). The 5-year recurrence-free survival rate of patients with a higher preoperative PLR (≥130) was significantly lower than that of patients with a lower preoperative PLR (<130) (89.4% vs. 96.8%, p=0.022). In the multivariate analysis, tumor size (p<0.001), T stage (p<0.001), Fuhrman grade (p=0.015) and preoperative hemoglobin (p=0.026) were independent prognostic factors for recurrence-free survival.

Conclusions: An increased preoperative NLR and PLR were associated with a higher recurrence rate in patients with non-metastatic clear cell RCC, although it was not an independent prognostic factor for recurrence-free survival.