Clinical Impact of Preoperative Neutrophil-Lymphocyte Ratio in Renal Cell Carcinoma in Sardjito Hospital
Background: Renal cell carcinoma (RCC) is one of the most common malignancies in the kidney and causes a mortality rate of more than 100,000 each year globally. The neutrophil-lymphocyte ratio (NLR) is one of the markers in the inflammatory response that also correlate with the alteration of any cancer cells. We investigated the correlation between the NLR on tumor stage, Fuhrman nuclear grade, length of stay (LOS), mortality, and recurrence rate in renal cell carcinoma.
Methods: We investigated 52 patients with renal cell carcinoma retrospectively from the databases of the patients who underwent radical and partial nephrectomy in Sardjito Hospital Yogyakarta between 2012 and 2017. Patients were classified as lower stage (T1-T2) and higher stage (T3-T4). We also classified it as a group of Fuhrman nuclear grade (G1, G2, G3, and G4). Two sample t-test or one-way ANOVA was used for the continuous variables and a chi-square test or Fisher’s exact test for the categorical variables. Pearson test was used to do the correlation test.
Results: Among a total of 52 patients analyzed in our study, there were 36 males (69%) and 16 females (31%). A normal distribution of datasets was verified. The mean of preoperative NLR in these 52 patients was 6.35 (+4.01), with a range of 1.48 - 21.0. The value of NLR was positively correlated with tumor pathologic stage (p = 0.020), length of stay of the patients (p = 0.00), and the mortality rate (p = 0.012). Neutrophil lymphocyte ratio was not significantly correlated with Fuhrman tumor grade (p = 0.357) and tumor recurrence (p = 0.670).
Conclusions: We compared the relationship of preoperative NLR with renal cell carcinoma tumor stage (T), Fuhrman grade, length of stay, mortality, and tumor recurrence. NLR was found to have a statistically significant higher T stage, mortality, and length of stay of the patients. Further studies with more patients are needed to confirm our study.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA. Cancer J Clin. 2015;65(1):5–29.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA. Cancer J Clin. 2018;68(1):7–30.
Padala SA, Barsouk A, Thandra KC et al. Epidemiology of renal cell carcinoma. Onkologe. 2019;11(3):79–87.
Volpe A, Patard JJ. Prognostic factors in renal cell carcinoma. World J Urol. 2010;28(3):319–27.
Lee JS, Kim NY, Na SH, et al. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine. 2018;97(26):e11138.
Rajandram R, Perumal K, Yap NY. Prognostic biomarkers in renal cell carcinoma: is there a relationship with obesity? Transl Androl Urol. 2019;8(Suppl 2):S138–S46.
Paner GP, Stadler WM, Hansel DE, et al. Updates in the eighth edition of the tumor-node-metastasis staging classification for urologic cancers. Eur Urol. 2018;73(4):560–9.
James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.
Klatte T, Rossi SH, Stewart GD. Prognostic factors and prognostic models for renal cell carcinoma: A literature review. World J Urol. 2018;36(12):1943–52.
Galdiero MR, Bonavita E, Barajon I, et al. Tumor associated macrophages and neutrophils in cancer. Immunobiology. 2013;218(11):1402–10.
Van Verschuer VMT, Hooning MJ, Van Baare-Georgieva RD, et al. Tumor-associated inflammation as a potential prognostic tool in BRCA1/2-associated breast cancer. Hum Pathol. 2015;46(2):182–190.
Mei Z, Shi L, Wang B, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1–13.
Otunctemur A, Dursun M, Besiroglu H et al. Clinical significance of preoperative neutrophil - to - lymphocyte ratio in renal cell carcinoma. Int Braz J Urol. 2016;42(4):678–84.
Minardi D, Scartozzi M, Montesi L, et al. Neutrophil-to-lymphocyte ratio may be associated with the outcome in patients with prostate cancer. Springerplus. 2015;4(1):1–5.
Bolat D, Aydoğdu Ö, Polat S, et al. Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors. Turk Urol Derg. 2017;43(1):55–61.
Kany S, Vollrath JT, Relja B. Cytokines in inflammatory disease. Int J Mol Sci. 2019;20(23):1–31.
Vijayakumar S, Viswanathan S, Aghoram R. Idiopathic CD4 lymphocytopenia : Current insights. Immunotargets Ther. 2020;9:79-93.
Zhang X, Zhang W, Feng LJ. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: A meta-analysis. PLoS One.
Binnewies M, Roberts EW, Kersten K, et al. Understanding the tumor immune microenvironment (TIME) for effective therapy. Nat Med. 2018;24(5):541–50.
Dai T, Lin G, Deng M, et al. The prognostic significance of neutrophil-to-lymphocyte ratio at different time points in patients with hepatocellular carcinoma receiving liver resection. Transl Cancer Res. 2020;9(2):441–57.
Pluhar GE, Pennell CA, Olin MR. CD8 + T Cell – Independent immune-mediated mechanisms of anti-tumor activity. 2015;35(2):153–72.
Han X, Bai S, Cui Y, et al. Essential role of CD4+ T cells for the activation of group 2 innate lymphoid cells during respiratory syncytial virus infection in mice. Immunotherapy. 2019;11(15):1303–13.
Imai N, Tawara I, Yamane M, et al. CD4+ T cells support polyfunctionality of cytotoxic CD8+ T cells with memory potential in immunological control of tumor. Cancer Sci. 2020;111(6):1958–68.
Yamanaka T, Matsumoto S, Teramukai, S et al. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology. 2008; 73(3–4):215–20.
Fogar P, Sperti C, Basso D, et al. Decreased total lymphocyte counts in pancreatic cancer: An index of adverse outcome. Pancreas. 2006;32(1):22–8.
Özgehan G, Kahramanca Ş, Kaya IO, et al. Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer. Turkish J Med Sci. 2014;44(3):365–8.
Tan YG, Sia J, Huang HH, Lau WKO. Neutrophil-to-lymphocyte ratio independently predicts advanced pathological staging and poorer survival outcomes in testicular cancer. Investig Clin Urol. 2019;60(3):176–83.
Kisa E, Yucel C, Keskin MZ, et al. The role of hematological parameters in predicting fuhrman grade and tumor stage in renal cell carcinoma patients undergoing nephrectomy. Medicina. 2019;55(6):287.
Arda E, Yuksel I, Cakiroglu B, et al. Valuation of Neutrophil/Lymphocyte Ratio in Renal Cell Carcinoma Grading and Progression. Cureus. 2018;10(1):e2051.
Patel A, Ravaud A, Motzer RJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor of disease-free survival in postnephrectomy high-risk locoregional renal cell carcinoma: Analysis of the S-TRAC trial. Clin Cancer Res. 2020;26(18):4863– 68.
Lalani AA, Xie W, Martini DJ, et al. Change in neutrophil-to-lymphocyte ratio (NLR) in response to immune checkpoint blockade for metastatic renal cell carcinoma. J Immunother. Cancer. 2018;6(1):5.
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