The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma

Abstract

Introduction: Prognosis in patients with cancer is influenced by underlying tumour biology and also the host inflammatory response to the disease. There is limited evidence to suggest that an elevated neutrophil-lymphocyte ratio (NLR) predicts a poorer prognosis in patients undergoing nephrectomy for renal cell carcinoma (RCC). The aim of this paper is to investigate if patients undergoing nephrectomy for RCC with NLR ≤4 have a better overall and recurrence-free survival than patients with NLR >4. Methods: All patients who underwent nephrectomy at a single centre between January 1, 2011 and December 31, 2014 were identified. Patients were included if postoperative histology demonstrated RCC and if preoperative GPS was available. Patients were excluded if nephrectomy was not curative intent (i.e., cytoreductive nephrectomy), if primary tumour was graded to be T3b-4 disease, if there was presence of nodal or metastatic disease on preoperative staging, or if adequate followup notes were not available. Primary and secondary outcomes were overall survival and recurrence-free survival, respectively. Results: A total of 154 patients were included in analysis of overall survival; 146 patients were included in analysis of recurrence-free survival. Patients with NLR ≤4 had a much better overall survival than patients with NLR >4 (95% vs 78%; p=0.0219). Patients with NLR >4 also had higher rates of recurrence (p=0.0218). Conclusion: NLR may be a useful tool in identifying patients who may benefit from more frequent surveillance in the early postoperative period and may allow clinicians to offer surveillance schemes tailored to the individual patient.

Preoperative Neutrophil Lymphocyte Ratio as a Prognostic Factor for Survival in Non-metastatic Renal Cell Carcinoma

“…This study demonstrated that NLR was an independent prognostic factor of OS in non-metastatic RCC. This finding is consistent with earlier studies for early-stage RCC both clear cell and non-clear cell subtypes [17][18][19][20][21] . NLR has been shown to associate with worse OS as a continuous and categorical variable.…”

“…NLR has been shown to associate with worse OS as a continuous and categorical variable. The cut-off level varied among studies ranged from 1.7 to 4.0, which covered the threshold in this study [19][20][21] . Although BMI and anemia were significant in univariate analysis, only older age, tumor size, and NLR were significantly associated with OS on tyrosine kinase, which has a central role in tumour carcinogenesis.…”

High Preoperative Plasma Fibrinogen Independently Predicts a Poor Prognosis in Patients with Nonmetastatic RCC

“…Fibrinogen is a plasma glycoprotein synthesised by the liver that is affected by systemic inflammation. Recently, numerous studies have revealed that inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil/lymphocyte ratio (NLR) are also significantly associated with tumorigenesis and affect the survival of a great number of cancers [26][27][28]. Therefore, as one of the most common acute phase inflammatory markers, the fibrinogen level may just be a superficial sign of inflammation related to cancer.…”

Predictive Value of Different Parameters for Estimating the First 90-days and Long-term Survival Following Radical Cystectomy

“…Recently, there observed an increase in the number of studies examining the effects of the serum hemogram parameters and inflammatory determinants on the oncologic results as far as the cancers of genitourinary system are concerned (25). During tumor proliferation, it is considered that there observed an increase in the rate of neutrophile due to the effects of the inflammatory cytokines primarily the interleukin -6 and the granulocyte colony stimulating factors (26).…”