Abstract
Introduction & Objectives
In systemic therapy trials, a decreasing neutrophil-to-lymphocyte ratio (NLR) after
treatment for metastatic renal cell carcinoma (RCC) has been associated with improved
oncologic outcomes. Paradoxically, for patients with localized RCC treated with upfront
surgery the opposite effect has been reported. We thus aimed to evaluate NLR dynamics
on localized RCC recurrence.
Materials and Methods
Treatment naïve patients with localized RCC managed surgically between 2005 and 2020
were included. Preoperative NLR was calculated within 6-weeks prior to surgery and
postoperative NLR was calculated between 4 and twelve-weeks after surgery. Patients
were followed for disease recurrence, noting metastatic sites and postoperative infections.
Cox regression were used to determine whether the relative change in postoperative
NLR was associated with metastasis-free survival (MFS) and cancer-specific survival
(CSS), adjusted for preoperative NLR.
Results
In the cohort of 3310 patients, 996 (30%) had postoperative NLR available. These patients
generally had more advanced disease, with 100 developing metastases and 38 dying from
kidney cancer. Median MFS follow-up was 4.4 years. Decreasing 2-month postoperative
NLR was associated with non–statistically significant worse MFS and CSS (HR 0.79,
95% 0.50, 1.24, P = .3; HR 0.83, 95% C.I. 0.40, 1.73; P = .6). On sensitivity analysis, across all NLR measurements, with NLR as a time-dependent
covariate, results were similar, with a declining NLR associated with adverse MFS
(HR 0.85, 95% CI 0.69, 1.30, P-value = .10), though not meeting conventional levels of significance.
Conclusion
In higher-risk localized RCC patients, postoperative NLR is not suitable as a biomarker
for predicting recurrences.
Keywords
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Article Info
Publication History
Published online: May 25, 2022
Accepted:
May 20,
2022
Received:
March 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
