title: Effect of hypertension on preoperative neutrophil-lymphocyte ratio evaluation of prognosis of renal cell carcinoma.
abstract: OBJECTIVE
  As an indicator of inflammatory reaction of immune system, the neutrophil-lymphocyte ratio (NLR) is a significantly independent prognostic factor of renal cell carcinoma (RCC). However, the NLR was not added in any well-established prognostic models. Many physiologic factors were also associated with NLR, such as hypertension. As such, we evaluated the effect of hypertension on NLR evaluation of prognosis of RCC.
  
  
  METHODS
  Hematological parameters and clinicopathological data during diagnosis were retrospectively recorded for 401 patients with RCC between the years 1999 and 2009. The standardized cutoff-finder algorithm was used to find the suitable NLR cutoff value for recurrence. The Log-rank test and Kaplan-Meier method were used to compare and estimate the recurrence-free survival. Univariate and multivariate Cox regression analyses were used to evaluate the association between NLR and clinicopathologic outcomes.
  
  
  RESULTS
  In the analysis of total subjects, recurrence-free survival was significantly worse among patients with a preoperative NLR (>3.139 [21.9%] vs.≤3.139 [78.1%]; P<0.001). High NLR value was associated with high pathological TNM stage (P = 0.009, 0.018, 0.001, respectively). In the normotensive subgroup, recurrence-free survival was also significantly worse among patients with a preoperative NLR (>3.139 [22.6%] vs.≤3.139 [77.4%]; P<0.001). However, in the subgroup with hypertension, the difference of recurrence-free survival was not significant between patients with preoperative NLR (>3.139 [21.2%] vs.≤3.139 [78.8%]; P = 0.093). Moreover, multivariate analysis identified increased NLR as a poor prognosis index for recurrence-free survival in total group (hazard ratio [HR] = 2.27; 95% CI: 1.50-3.44; P<0.001) and normotensive subgroup (HR = 2.97; 95% CI: 1.74-5.07; P<0.001), but not in hypertensive subgroup (HR = 1.25; 95% CI: 0.59-2.65; P = 0.566).
  
  
  CONCLUSIONS
  Hypertension is a disturbance factor in the evaluation of prognosis of RCC by preoperative NLR.
authors.affiliation: Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China.
authors.forename: Jia
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Urology, Provincial Hospital, Shandong University, Shandong, PR China. Electronic address: haoning82@gmail.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Ning
authors.affiliation: Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China.
authors.forename: Jintang
authors.initials: J
authors.lastname: Sun
authors.affiliation: Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China. Electronic address: quxun@sdu.edu.cn.
authors.forename: Xun
authors.initials: X
authors.lastname: Qu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
keywords: Hypertension; Neutrophil-lymphocyte ratio; Prognosis; Renal cell carcinoma