1. Prognostic Impact of Preoperative Neutrophil-to-Lymphocyte Ratio in Localized Nonclear Cell Renal Cell Carcinoma.
- Author
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de Martino, Michela, Pantuck, Allan J., Hofbauer, Sebastian, Waldert, Matthias, Shariat, Shahrokh F., Belldegrun, Arie S., and Klatte, Tobias
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CANCER treatment ,PREOPERATIVE care ,NEUTROPHILS ,RENAL cell carcinoma ,MEDICAL databases ,LYMPHOCYTES ,DRUG design ,CLINICAL trials ,PROGNOSIS - Abstract
Purpose: The preoperative neutrophil-to-lymphocyte ratio was proposed as a prognostic factor for localized clear cell renal cell carcinoma. We evaluated its role in nonclear cell renal cell carcinoma. Materials and Methods: We queried 2 prospective kidney cancer databases. Patients who underwent full resection of localized (T1-3 N0/+ M0) nonclear cell renal cell carcinoma by radical or partial nephrectomy were included in analysis. Associations of the continuously coded neutrophil-to-lymphocyte ratio with disease-free survival were assessed with univariable and multivariable Cox regression models. Prognostic accuracy was evaluated with the Harrell concordance index. Results: Our final cohort included 281 patients. The 5-year disease-free survival rate was 88.1%. The neutrophil-to-lymphocyte ratio was significantly associated with disease-free survival. With each 1.0 increase in the ratio the risk of recurrence increased by 15% (HR 1.15, p = 0.028). On multivariable analysis TNM group (HR 2.84, p = 0.025), Fuhrman grade (HR 3.40, p <0.001) and the neutrophil-to-lymphocyte ratio (HR 1.17, p = 0.022) were independently associated with disease-free survival. Adding the neutrophil-to-lymphocyte ratio improved the accuracy of a base model to predict disease-free survival from 78.8% to 80.8%. Conclusions: The neutrophil-to-lymphocyte ratio is an independent prognostic factor for disease-free survival after surgery with curative intent for localized nonclear cell renal cell carcinoma. It significantly increases the accuracy of established prognostic factors. The neutrophil-to-lymphocyte ratio may provide a meaningful adjunct for patient counseling and clinical trial design. [Copyright &y& Elsevier]
- Published
- 2013
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