The Prognostic Significance Of Inflammation-Associated Blood Cell Markers In Non-Metastatic Clear Cell Renal Cell Carcinoma

Abstract Objectives Our objective is to evaluate the impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) and red-cell distribution width (RDW) on survival outcomes of non-metastatic clear cell renal cell carcinoma (ccRCC). Methods We accessed our single-centre, uro-oncological registry to extract data of patients who were treated for non-metastatic ccRCC with nephrectomy. Optimal cut-off for these markers were determined using X-tile software and survival analyses using cox-regression were performed. Results 687 patients underwent nephrectomy. The optimum cut-offs for NLR, PLR, LMR and RDW were 3.3, 210, 2.4 and 14.3% respectively. NLR, PLR, LMR and RDW were significantly associated with larger pathological tumour size, tumour stage, more aggressive Fuhrman grade and presence of tumour necrosis. After adjusting for age, baseline ECOG, pathological tumour, nodal stage and Fuhrman grade, only PLR remained an independent prognostic marker for both cancer-specific survival and overall survival (CSS: HR 2.69, 95%CI: 1.36 – 5.33, p=0.004 and OS: HR 2.19, 95%CI: 1.36 – 3.50, p=0.001). When PLR was included with the Leibovich score and UCLA Integrated Staging System (UISS), the Harrell’s c-index increases from 0.854 to 0.876 and 0.751 to 0.810 respectively for CSS at 5-years post-nephrectomy. When risk-stratified by Leibovich risk group and UISS, PLR was demonstrated to be a significant prognostic factor only within the intermediate to high risk groups. Conclusion PLR is a robust prognostic marker in non-metastatic ccRCC that clearly outperforms other inflammatory indices in those who had undergone nephrectomy. However, its prognostic impact is limited in low-risk category of ccRCC.