title: Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Nonmetastatic Renal Cell Carcinoma: A Large, Multicenter Cohort Analysis.
abstract: Background. The prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in nonmetastatic renal cell carcinoma (non-mRCC) is controversial, although NLR has been established as a prognostic factor in several cancers. The objective of our study was to assess the prognostic significance of preoperative NLR in non-mRCC, based on a large, multicenter cohort analysis.Methods. Totally, 1,284 non-mRCC patients undergoing surgery were enrolled from six institutions between 2000 and 2014. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were calculated, and the prognostic significance of NLR was evaluated.Results. Patients with higher NLR had larger tumors (p< 0.001), higher T stage (p< 0.001), worse Eastern Cooperative Oncology Group performance status (p< 0.001), worse symptoms (p= 0.003), sarcomatoid differentiation (p= 0.004), and tumor necrosis (p< 0.001). The 5-year RFS and CSS rates were significantly lower in patients with high NLR than in those with low NLR (eachp< 0.001). Multivariate analysis identified NLR to be an independent predictor of RFS and CSS (eachp< 0.05). Moreover, predictive accuracy of multivariate models for RFS and CSS increased by 2.2% and 4.2%, respectively, with NLR inclusion.Conclusions. Higher NLR was associated with worse clinical behavior of non-mRCC. Also, NLR was a significant prognostic factor of both RFS and CSS.
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, College of Medicine, Chonnam National University, Gwangju, Republic of Korea.
authors.forename: Eu Chang
authors.identifier: 0000-0002-2031-124X
authors.initials: EC
authors.lastname: Hwang
authors.affiliation: Department of Urology, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Urology, College of Medicine, Catholic University, Seoul, Republic of Korea.
authors.forename: Sung-Hoo
authors.initials: SH
authors.lastname: Hong
authors.affiliation: Department of Urology, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Jinsoo
authors.identifier: 0000-0003-2251-5331
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Urology, College of Medicine, Kyungpook National University, Daegu, Republic of Korea.
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Yong-June
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Urology, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
authors.forename: Won Ki
authors.identifier: 0000-0001-7172-0636
authors.initials: WK
authors.lastname: Lee
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis