title: Prognostic impact of preoperative neutrophil-to-lymphocyte ratio in localized nonclear cell renal cell carcinoma.
abstract: OBJECTIVE
  The preoperative neutrophil-to-lymphocyte ratio was proposed as a prognostic factor for localized clear cell renal cell carcinoma. We evaluated its role in nonclear cell renal cell carcinoma.
  
  
  METHODS
  We queried 2 prospective kidney cancer databases. Patients who underwent full resection of localized (T1-3 N0/+ M0) nonclear cell renal cell carcinoma by radical or partial nephrectomy were included in analysis. Associations of the continuously coded neutrophil-to-lymphocyte ratio with disease-free survival were assessed with univariable and multivariable Cox regression models. Prognostic accuracy was evaluated with the Harrell concordance index.
  
  
  RESULTS
  Our final cohort included 281 patients. The 5-year disease-free survival rate was 88.1%. The neutrophil-to-lymphocyte ratio was significantly associated with disease-free survival. With each 1.0 increase in the ratio the risk of recurrence increased by 15% (HR 1.15, p=0.028). On multivariable analysis TNM group (HR 2.84, p=0.025), Fuhrman grade (HR 3.40, p<0.001) and the neutrophil-to-lymphocyte ratio (HR 1.17, p=0.022) were independently associated with disease-free survival. Adding the neutrophil-to-lymphocyte ratio improved the accuracy of a base model to predict disease-free survival from 78.8% to 80.8%.
  
  
  CONCLUSIONS
  The neutrophil-to-lymphocyte ratio is an independent prognostic factor for disease-free survival after surgery with curative intent for localized nonclear cell renal cell carcinoma. It significantly increases the accuracy of established prognostic factors. The neutrophil-to-lymphocyte ratio may provide a meaningful adjunct for patient counseling and clinical trial design.
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of California-Los Angeles (AJP, ASB), Los Angeles, California.
authors.forename: Michela
authors.initials: M
authors.lastname: de Martino
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hofbauer
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldert
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000276:immunology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000276:immunology; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies
keywords: ALC; ANC; DFS; MVI; NLR; RCC; absolute lymphocyte count; absolute neutrophil count; carcinoma; disease-free survival; kidney; lymphocytes; microvascular invasion; mortality; neutrophil-to-lymphocyte ratio; neutrophils; renal cell; renal cell carcinoma