title: Critical evaluation of the potential prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio under consideration of C-reactive protein levels in clear cell renal cell carcinoma.
abstract: We investigated the prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio (dNLR) and original NLR in relation to the commonly used inflammation marker C-reactive protein (CRP) in a large cohort of patients with clear cell renal cell carcinoma (RCC).
  
  
  
  Clinicopathological data from 587 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single tertiary academic center, were evaluated retrospectively. Patients were categorised according to a cutoff value derived from receiver operating curve analysis. Overall (OS), cancer-specific (CSS) as well as metastasis-free survival (MFS) were assessed using the Kaplan-Meier method and multivariate Cox proportional models were applied. Spearman's rank correlation coefficient tested the association between dNLR and other markers of the systemic inflammatory response.
  
  
  
  The significant correlation between pretreatment NLR and dNLR was strong (ρ=0.84), whereas between dNLR and CRP it was weak (ρ=0.18). In multivariate analyses, dNLR achieved independent predictor status regarding CSS (P=0.037) and MFS (P=0.041), whereas CRP was confirmed as independent predictor of OS (P=0.010), CSS (P=0.039) and MFS (P=0.005), respectively. The NLR failed to reach independent predictor status regarding OS, CSS and MFS when CRP was included into the multivariate model.
  
  
  
  In the cohort studied, an elevated (⩾10.0) pretreatment CRP level and elevated dNLR (>2) were robust independent predictors of CSS and MFS. Our data suggest that CRP might be superior to both NLR and dNLR.
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Theresa
authors.initials: T
authors.lastname: Luef
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Seles
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 25, Graz A-8036, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Stotz
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, Graz A-8036, Austria.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz A-8036, Austria.
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 25, Graz A-8036, Austria.|Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, South Campus Research Building 4, 1901 East Road, Houston, TX 77054, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein