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

  • Kim, Tae Woo (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Lee, Jung Hwan (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Shim, Kang Hee (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Choo, Seol Ho (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Choi, Jong Bo (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Ahn, Hyun Soo (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Kim, Se Joong (Department of Urology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Kim, Sun Il (Department of Urology, Ajou University Hospital, Ajou University School of Medicine)
  • Received : 2018.06.04
  • Accepted : 2018.10.22
  • Published : 2019.01.22

Abstract

Purpose: To evaluate the significance of preoperative and follow-up neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for recurrence in patients with non-metastatic clear cell renal cell carcinoma (NMCCRCC). Materials and Methods: We retrospectively reviewed the medical records of 309 patients with NMCCRCC who underwent radical or partial nephrectomy. The prognostic significance of various clinicopathological variables, preoperative NLR (pNLR) and PLR (pPLR), and NLR and PLR at recurrence or quasi-recurrence (rNLR and rPLR) for recurrence-free survival (RFS) was analyzed. Results: At mean follow-up of 93 months, 44 patients (14.2%) developed recurrence. In the univariate analysis, clinical presentation, tumor size, pathologic tumor stage, Fuhrman grade, pNLR, pPLR and rNLR were significant prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as continuous variables, tumor size, pathologic tumor stage and pPLR were independent prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as dichotomous variables, tumor size, pathologic tumor stage, Fuhrman grade and pNLR ≥1.7 were independent prognostic factors for RFS. In multivariate analyses using rNLR and rPLR, only tumor size and pathologic tumor stage were independent prognostic factors for RFS. In a subset of patients with recurrence or at least 42 months follow-up without recurrence, rNLR ≥1.9 was significantly associated with worse RFS, albeit without independent significance. Conclusions: pNLR and pPLR are independent prognostic factors for RFS in patients with NMCCRCC. We propose that postoperative follow-up NLR of 1.9 and higher with one or more adverse clinicopathological factors should prompt radiologic evaluation for possible metastasis.

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