title: Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients.
abstract: BACKGROUND
  Emerging evidences indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors for improving predictive accuracy in renal cell carcinoma (RCC). We aimed to evaluate the prognostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR) and serum C-reactive protein (CRP) in RCC.
  
  
  METHODS
  484 surgical RCC patients were enrolled from 2006 to 2010 in this study. Receiver operating curve (ROC) was applied to assess the optimal cutoff levels for four biomarkers, and the prognostic values were determined by Kaplan-Meier curve, univariate and multivariate COX regression models. The predictive accuracy was evaluated by concordance index (c-index).
  
  
  RESULTS
  The median follow-up duration after surgical resection was 36 months. The optimal cutoff levels were 2.78 for NLR, 2.05 for dNLR, 185 for PLR and 5.1 for CRP by ROC curves analysis. Elevated NLR, dNLR, PLR and CRP were significantly correlated with worse overall survival (OS). Multivariate analysis showed that elevated NLR was an independent risk factor for OS, and NLR was superior to dNLR, PLR and CRP based on hazard ratio (HR 2.10, 95 % CI 1.21-3.64, P = 0.008). Additionally, the nomogram could more effectively work in predicting OS (c-index: 0.749) in surgical RCC patients.
  
  
  CONCLUSIONS
  Pre-operation NLR can be considered as a potential prognostic biomarker in patients with RCC who underwent surgical resection.
authors.affiliation: Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China.
authors.forename: Xiajuan
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Nephrology, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, Hangzhou, Zhejiang, China.
authors.forename: Xiangcheng
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhengjiang, China.
authors.forename: Chuanming
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 163 Shoushan Road, Jiangyin, 214400, Jiangsu, China. xiawenkai23@163.com.
authors.forename: Wenkai
authors.initials: W
authors.lastname: Xia
authors.affiliation: Department of Oncology, Hangzhou First People's Hospital, Hangzhou Hospital Affiliated to Nanjing Medical University, 261 Huansha Road, Hangzhou, 310006, Zhejiang, China. mashenglin@medmail.com.cn.
authors.forename: Shenglin
authors.initials: S
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets; D002097:C-Reactive Protein / Q000032:analysis*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000601:surgery*; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Neutrophil-to-lymphocyte ratio; Prognosis; Renal cell carcinoma; Survival