title: Preoperative Neutrophil-to-Lymphocyte Ratio and Neutrophilia Are Independent Predictors of Recurrence in Patients with Localized Papillary Renal Cell Carcinoma.
abstract: OBJECTIVE
  To evaluate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) and absolute neutrophil count (ANC) in patients' prognosis with localized papillary renal cell carcinoma (pRCC).
  
  
  METHODS
  Data from 218 localized pRCC patients (T1-3 N0/+ M0), operated between 1991 and 2011 at two centers, were evaluated retrospectively. Univariable and multivariable analyses using the Cox regression model were performed to determine the associations of NLR and ANC with recurrence-free survival (RFS). Prognostic accuracy was evaluated with the Harrell concordance index.
  
  
  RESULTS
  The 5-year RFS rate was 87.0%. Multivariable analysis identified increased NLR (≥3.6) and ANC (≥5300/μL) as independent prognostic factors for RFS (hazard ratio (HR) = 4.01, P = 0.018) and (HR = 4.71, P = 0.045). The final model built by the addition of NLR or ANC improved predictive accuracy (c-index: 0.824, 0.842) compared with the clinicopathological base model (c-index: 0.800), which included TNM stage and tumor necrosis.
  
  
  CONCLUSIONS
  The NLR and ANC appear to be independent prognostic factors for RFS after surgery for localized pRCC. They significantly increase the accuracy of established prognostic factors. Therefore, we recommend adding NLR and ANC to traditional prognostic model, which may improve its predictive accuracy.
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200123, China.
authors.forename: Jiwei
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Dahl
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200123, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200123, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Cornejo
authors.affiliation: Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Shulin
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Feldman
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200123, China.
authors.forename: Yiran
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200123, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xue
authors.affiliation: Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA ; Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
mesh_terms: D001900:Boston / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D007958:Leukocyte Count / Q000706:statistics & numerical data; D007960:Leukocyte Disorders / Q000453:epidemiology / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology*; D009504:Neutrophils / Q000473:pathology; D011300:Preoperative Care / Q000706:statistics & numerical data; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity