Validation of the pre-treatment neutrophil–lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients

Abstract

Background:The neutrophil–lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Several studies suggest a negative impact of increased NLR for patient's survival in different types of cancer. However, previous findings from small-scale studies revealed conflicting results about its prognostic significance with regard to different clinical end points in non-metastatic renal cell carcinoma (RCC) patients. Therefore, the aim of our study was the validation of the prognostic significance of NLR in a large cohort of RCC patients.Methods:Data from 678 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single centre, were evaluated retrospectively. Cancer-specific, metastasis-free, as well as overall survival (OS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of NLR, multivariate Cox regression models were applied for all three different end points. Influence of the NLR on the predictive accuracy of the Leibovich prognosis score was determined by Harrell's concordance index.Results:Multivariate analysis identified increased NLR as an independent prognostic factor for overall (hazard ratio (HR)=1.59, 95% confidence interval (CI)=1.10–2.31, P=0.014), but not for cancer-specific (HR=1.59, 95% CI=0.84–2.99, P=0.148), nor for metastasis-free survival (HR=1.39, 95% CI=0.85–2.28, P=0.184). The estimated concordance index was 0.79 using the Leibovich risk score and 0.81 when NLR was added.Conclusion:Regarding patients' OS, an increased NLR represented an independent risk factor, which might reflect a higher risk for severe cardiovascular and other comorbidities. Adding the NLR to well-established prognostic models such as the Leibovich prognosis score might improve their predictive ability.

Neutrophil-lymphocyte ratio in small renal masses.

“…This is in contrast to Pichler et al [25] finding in a large European validation study of pretreatment NLR prognostication of RCC in 678 patients, where preoperative NLR elevation was associated with worse OS but not cancer specific outcomes. Pichler et al [25] concluded that elevated NLR reflects patients' severe cardiovascular and medical comorbidities. Contrary to those studies [12,13,25], we did incorporate patients' demographics and medical comorbidities in our analyses.…”

Haematologic Parameters in Metastatic Colorectal Cancer Patients Treated with Capecitabine Combination Therapy

“…Elevated NLR have also been repeatedly demonstrated as a significantly prognostic factor for some other types of cancer (Noh et al, 2013;Pichler et al, 2013;Shibutani et al, 2013). Patients with elevated NLR have a relative lymphocytopenia and, as a result, may exhibit a poorer lymphocyte-mediated immune response to malignancy; thereby worsening their prognosis.…”

The neutrophil-to-lymphocyte ratio is an effective prognostic marker in localized upper urinary tract urothelial carcinoma treated with nephroureterectomy

“…In particular, C-reactive protein as a systemic inflammation marker was reported to be a poor prognostic factor in several types of cancers [6,7]. Others and we have also revealed that neutrophil-to-lymphocyte ratio (NLR) is an independent prognostic factor in various solid malignancies, including renal cell carcinoma, bladder urothelial carcinoma, and prostatic carcinoma [8][9][10][11][12][13]. Of note, NLR can be easily calculated from complete blood counts (CBCs) in the peripheral blood, and this parameter can be used both pre-and post-operatively.…”