title: Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis.
abstract: OBJECTIVE
  Increasing evidence suggests that cancer-associated inflammation is associated with poor prognosis in patients with cancer. The role of the neutrophil-lymphocyte ratio (NLR) as a predictor in renal cell carcinoma (RCC) remains controversial. We conducted the meta-analysis to determine the association between NLR and clinical outcome of patients with RCC.
  
  
  METHODS
  Studies were identified from PubMed and EMBASE databases in March 2014. Meta-analysis was performed to generate combined HRs with 95% CIs for overall survival (OS) and recurrence-free/progress-free survival (RFS/PFS).
  
  
  RESULTS
  15 cohorts containing 3357 patients were included. Our analysis results indicated that elevated NLR predicted poorer OS (HR=1.82, 95% CI 1.51 to 2.19) and RFS/PFS (HR=2.18, 95% CI 1.75 to 2.71) in patients with RCC. These findings were robust when stratified by study region, sample size, therapeutic intervention, types of RCC and study quality. However, it differed significantly by assessment of the cut-off value defining 'elevated NLR' in RFS/PFS (p=0.004). The heterogeneity in our meta-analysis was mild to moderate.
  
  
  CONCLUSIONS
  Elevated NLR indicates a poorer prognosis for patients with RCC. NLR should be monitored in patients with RCC for rational risk stratification and treatment individualisation.
authors: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Kaimin
authors: K
authors: Hu
authors: Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Lixia
authors: L
authors: Lou
authors: Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Juan
authors: J
authors: Ye
authors: Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
authors: Suzhan
authors: S
authors: Zhang
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000628:therapy; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000628:therapy; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor