title: The prognostic utility of preoperative neutrophil-to-lymphocyte ratio in localized clear cell renal cell carcinoma.
abstract: BACKGROUND
  To explore whether the association between preoperative neutrophil-to-lymphocyte ratio (NLR) elevation and worse survival is of use prognostically or merely a reflection of medical comorbidities in clear cell renal cell carcinoma (CC RCC).
  
  
  METHODS
  We identified 1970 patients treated at Memorial Sloan Kettering Cancer Center from 1998-2012 by partial or radical nephrectomy for non-metastatic CC RCC. NLR was calculated by dividing absolute neutrophil count by absolute lymphocyte count; both were obtained from preoperative complete blood count. Uni- and multivariable Cox proportional hazards regression, which included established prognostic variables, were used to test for association between NLR and recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS).
  
  
  RESULTS
  Univariate analysis identified elevated NLR as significantly associated with worse RFS, CSS, and OS (all p < 0.0001). However, upon multivariable analysis, elevated NLR was significantly associated with only worse OS (p < 0.0001). After adding markers of comorbidity that were significantly correlated with NLR elevation-higher American Society of Anesthesiologists class (p = 0.013), older age, and higher estimated glomerular filtration rate (both p < 0.0001)--into the multivariable model, NLR remained significantly associated with OS (p = 0.001). The addition of NLR into the prognostic model for OS did not increase Harrell's concordance index from 0.776.
  
  
  CONCLUSIONS
  In our cohort, preoperative NLR elevation is associated with worse OS, but there was no significant association with RFS or CSS on multivariable analysis. Preoperative NLR does not add unique prognostic information for patients undergoing surgical resection of renal tumors.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Wassim M
authors.initials: WM
authors.lastname: Bazzi
authors.forename: Amy L
authors.initials: AL
authors.lastname: Tin
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sjoberg
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D007958:Leukocyte Count; D018655:Lymphocyte Count; D009504:Neutrophils; D057234:Preoperative Period; D011379:Prognosis