Neutrophil-to-Lymphocyte Ratio Predicts Cancer Outcome in Locally Advanced Clear Renal Cell Carcinoma |
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| Affiliation: | 1. Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil;2. Divisão de Oncologia, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil;1. Laboratory of Medical Investigation – LIM55, Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil;2. Instituto do Cancer do Estado de São Paulo – ICESP, São Paulo, Brazil;1. Department of Molecular Carcinogenesis, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;2. Department of Pathology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;3. Department of Medical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;4. Core Facility Molecular Pathology & Biobanking, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;5. Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;6. Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany;1. Department of Maternal Infant and Urologic Sciences, \"Sapienza\" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy;2. Department of Urology, Stanford Medical Center, Stanford, CA;3. Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy;4. Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy;5. Department of Urology, IEO, European Institute of Oncology IRCCS, Milan, Italy;6. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy;7. Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroc?aw Medical University, 50-556 Wroclaw, Poland;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria;9. USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA;10. Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy;11. Department of Urology, Molinette Hospital, University of Turin, Turin, Italy;12. Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy;13. Division of Urology, VCU Health System, Richmond, VA;1. Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA;2. Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA;3. Department of Urology, Thomas Jefferson University, Philadelphia, PA;4. MedStar Health, Institute for Innovation, Washington, DC;5. Jefferson Digital Innovation and Consumer Experience, Thomas Jefferson University, Philadelphia, PA;6. NYU-Langone Health, New York, NY;7. Manhattan Veterans Affairs Hospital, New York, NY;1. School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan;2. Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine; and Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan;1. Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO;2. Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA;3. Department of Radiation Oncology, Sylvester Cancer Center, University of Miami, FL;4. Biostatistics, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO;5. Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA |
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| Abstract: | BackgroundTo evaluate the association of neutrophil-to-lymphocyte ratio (NLR) with recurrence-free survival (RFS) and overall survival (OS) in patients with locally advanced nonmetastatic clear cell renal cell carcinoma (ccRCC) undergoing radical nephrectomy.Material and MethodsWe retrospectively identified 880 nephrectomies performed between January 2009 and December 2016 in a single center, reviewed data from 478 radical nephrectomies for kidney tumors and identified 187 patients with locally advanced nonmetastatic ccRCC (pT3-T4 N0M0). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. OS and RFS were evaluated by the Kaplan–Meier method. Cox proportional-hazards regression models were used to evaluate predictors of RFS and OS.ResultsAmong 187 patients with ccRCC (mean age 63.4 ± 11.5 years; 118 63.1%] male), the median follow-up was 48.7 months. On univariate analysis, in patients with Fuhrman nuclear grade of differentiation 3-4, the median time to recurrence was significantly shorter with NLR ≥ 4 than < 4 (24 vs. 55 months, P = .045). On multivariable analysis adjusted for NLR ≥ 4, among all variables analyzed (NLR, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index), only nuclear grade of differentiation was an independent predictor of recurrence (hazard ratio 2.18; 95% confidence interval 1.07-4.92, P = .03). The 3-year OS had no statistically significant difference between patients with NLR ≥ 4 or < 4.ConclusionFor patients with locally advanced, nonmetastatic ccRCC, RFS was reduced with high nuclear grade of differentiation and high preoperative NLR. These findings suggest an association between higher NLR and worse outcomes in locally advanced ccRCC. |
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| Keywords: | kidney tumor biomarker non-metastatic |
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