Abstract
Background
To 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 Methods
We 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.
Results
Among 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.
Conclusion
For 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.
Keywords
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Article info
Publication history
Published online: November 22, 2021
Accepted:
October 15,
2021
Received in revised form:
October 11,
2021
Received:
October 17,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
