title: Pre-treatment neutrophil-to-lymphocyte ratio predicts tumor pathology in newly diagnosed renal tumors.
abstract: OBJECTIVE
  The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes after surgical treatment for clear cell renal cell carcinoma (ccRCC). However, its ability to distinguish aggressive from indolent renal tumors remains unknown. We therefore evaluated the association between NLR and pathologic outcomes at nephrectomy.
  
  
  METHODS
  From 1995 to 2008, 2402 patients underwent radical or partial nephrectomy for localized renal tumors. Of these, 2039 had an NLR within 90 days prior to surgery. Comparisons of NLR by tumor size, histologic subtype, and nuclear grade were evaluated.
  
  
  RESULTS
  Benign renal masses had a significantly lower NLR than malignant tumors (median 2.92 vs. 3.12; p = 0.037) with the greatest difference noted among renal lesions >7 cm (median 2.79 vs. 3.87; p < 0.001). There was a significant difference in NLR among RCC subtypes (p = 0.002), with cystic ccRCC demonstrating the lowest (median 2.48) and collecting duct RCC the highest NLR (median 5.99). Moreover, there was a significant increase in NLR with larger tumor size and greater nuclear grade (p < 0.001). Specifically, in patients with ccRCC, an incremental increase in tumor size (≤4 cm = 2.80, >4 but ≤7 cm = 3.09 and >7 cm = 3.95) and nuclear grade (G1 = 2.68, G2 = 2.87, G3 = 3.48, and G4 = 5.18) was associated with greater NLR (p < 0.001).
  
  
  CONCLUSIONS
  An elevated NLR is associated with RCC pathology, higher-grade tumors, and more aggressive histologic subtypes at the time of nephrectomy. Therefore, NLR appears to be a preoperative marker of biologically aggressive RCC and may be useful in predicting malignancy and guiding management among patients with suspicious renal tumors.
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA. tollefson.matthew@mayo.edu.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D047368:Tumor Burden
keywords: Biomarker; Nephrectomy; Neutrophil-to-lymphocyte ratio; Nuclear grade; Renal cell carcinoma; Small renal mass; Tumor size