title: Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma.
abstract: OBJECTIVE
  We investigated the prognostic significance of the neutrophil-to-lymphocyte ratio to predict recurrence in patients with nonmetastatic renal cell carcinoma.
  
  
  METHODS
  We retrospectively reviewed the records of 192 patients with nonmetastatic renal cell carcinoma (T1-4N0M0) who underwent nephrectomy between 1986 and 2000. Mean followup was 93 months (range 6 to 232) months. We assessed the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio, and other clinical and laboratory parameters on univariate and multivariate analysis.
  
  
  RESULTS
  Presentation mode, tumor stage, C-reactive protein, lymphocyte count and the neutrophil-to-lymphocyte ratio significantly correlated with recurrence-free survival on univariate analysis. The recurrence-free survival rate in patients with a neutrophil-to-lymphocyte ratio of less than 2.7 was 93.7% at 5 years and 79.8% at 10 years, significantly higher than the 77.9% and 58.4%, respectively, in patients with a ratio of 2.7 or greater (p = 0.0205). Multivariate analysis revealed that T stage and the neutrophil-to-lymphocyte ratio were independent predictors of recurrence. The 10-year survival rate in patients at low risk (T2 or less and neutrophil-to-lymphocyte ratio less than 2.7), intermediate risk (T2 or less and ratio 2.7 or greater, or T3 or greater and ratio less than 2.7) and high risk (T3 or greater and ratio 2.7 or greater) was 82.0%, 63.6% and 33.0%, respectively, which were significantly different.
  
  
  CONCLUSIONS
  An increased pretreatment neutrophil-to-lymphocyte ratio is an independent predictor of recurrence. The combination of T stage and the neutrophil-to-lymphocyte ratio can be used to stratify recurrence risk in patients with nonmetastatic renal cell carcinoma.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan. yoshio-o@tokyo-med.ac.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohno
authors.forename: Jun
authors.initials: J
authors.lastname: Nakashima
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohori
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hatano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000276:immunology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000276:immunology*; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000276:immunology*; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult