Predictive value of preoperative neutrophil-to-lymphocyte ratio in non-metastatic papillary renal cell carcinoma patients after receiving curative surgery
Received 10 April 2019
Accepted for publication 28 July 2019
Published 7 August 2019 Volume 2019:11 Pages 7515—7524
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Xiang Tu,1,* Fan Wang,1,* Tiancong Chang,2,* Chichen Zhang,2 Mengni Zhang,3 Zhenhua Liu,1 Shi Qiu,1 Lu Yang,1 Qiang Wei1
1Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Department of Pathology and Laboratory of Pathology, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People’s Republic of China
*These authors contributed equally to this work
Objective: To determine the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for disease-free survival (DFS) in non-metastatic papillary renal cell carcinoma (pRCC) patients following partial or radical nephrectomy.
Methods: We retrospectively analyzed 315 non-clear cell RCC patients who received curative surgery in our hospital from 2013 to 2018, from which 76 pRCC patients without metastasis (T1-3N0M0) were selected. The receiver operating characteristics (ROC) curve was drawn and an NLR cut-off of 2.5 was set to achieve maximum diagnostic accuracy for predicting DFS. Kaplan-Meier method and the Cox regression model was used to determine the relationship of NLR with DFS.
Results: During a median follow-up of 28.0 months (IQR 15.9–42.1, mean 31.4), disease recurred in 12 patients (15.8%) recording a median duration of 14.4 months (IQR 8.6–22.9, mean 16.6). The 5-year DFS was 85.5% and 61.6% for the low (<2.5) and high (≥2.5) NLR groups respectively. According to Kaplan-Meier analysis, DFS was significantly lower in the high NLR group compared with that in the low NLR group (p=0.03). Univariate analysis revealed that high NLR level (HR 3.3, p=0.041), advanced pathological T stage (HR 10.1, p<0.001), larger tumor size (HR 1.2, p=0.008) and radical nephrectomy (HR 5.7, p=0.025) were associated with poor DFS, while multivariate analysis indicated that only advanced pathological T stage (HR 6.9, p=0.010) and high NLR level (HR 3.8, p=0.028) remained as the independent prognostic factors for poor DFS.
Conclusion: A high preoperative NLR level was an independent prognostic marker for DFS in the patients of non-metastatic pRCC (pT1-3N0M0) following curative surgery. This can be used as an adjuvant tool to select patients for clinical trials or more frequent follow-up strategies.
Keywords: neutrophil-to-lymphocyte ratio, papillary renal cell carcinoma, prognostic factor, renal cell cancer
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