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The predictive role of preoperative and postoperative neutrophil-lymphocyte ratio in sarcomatoid renal cell carcinoma.

ABSTRACT: OBJECTIVE:Preoperative inflammatory parameters are associated with outcome in renal cell carcinoma; however, their predictive value in tumors with sarcomatoid dedifferentiation (sRCC) is uncertain. We aimed to evaluate the association between preoperative and postoperative inflammatory parameters and the outcome of patients with locoregional and metastatic sRCC who underwent nephrectomy. METHODS AND MATERIALS:After obtaining IRB approval, we identified 230 patients with sRCC treated between 1994 and 2018 with a complete blood count drawn ?1 month before nephrectomy. Preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio, and platelet-lymphocyte ratio were evaluated as continuous variables. Postoperative NLR, 1 to 8 weeks after surgery, and percentage change in NLR were calculated. Cox regression models were used to identify predictors of outcome. RESULTS:The study cohort included 105 metastatic patients and 112 patients with locoregional disease. Patients with metastatic disease had significantly higher preoperative NLR (4.31 vs. 3.29) and PLR (248 vs. 194), and lower preoperative LMR (2.6 vs. 3.23). Median follow-up for patients with locoregional and metastatic disease was 36 months and 20 months, respectively, and estimated 5-year cancer-specific survival (CSS) rates were 56% and 15%, respectively. Preoperative NLR was a significant predictor of CSS for both metastatic (HR?=?1.23, 95% CI 1.1-1.37, P < 0.001) and locoregional (HR?=?1.09, 95% CI 1-1.2, P?=?0.049) patients. For metastatic patients, postoperative NLR was significantly associated with CSS on univariate analysis; however, change in NLR was not associated with outcome. CONCLUSIONS:Preoperative NLR is associated with CSS in locoregional and metastatic sRCC. NLR should be considered when establishing future predictive models for sRCC.

SUBMITTER: Mano R

PROVIDER: S-EPMC7224592 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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The predictive role of preoperative and postoperative neutrophil-lymphocyte ratio in sarcomatoid renal cell carcinoma.

Mano Roy R Flynn Jessica J Blum Kyle A KA Silagy Andrew W AW DiNatale Renzo G RG Marcon Julian J Wang Alan A Sanchez Alejandro A Coleman Jonathan A JA Russo Paul P Ostrovnaya Irina I Hakimi A Ari AA

Urologic oncology 20191004 12

<h4>Objective</h4>Preoperative inflammatory parameters are associated with outcome in renal cell carcinoma; however, their predictive value in tumors with sarcomatoid dedifferentiation (sRCC) is uncertain. We aimed to evaluate the association between preoperative and postoperative inflammatory parameters and the outcome of patients with locoregional and metastatic sRCC who underwent nephrectomy.<h4>Methods and materials</h4>After obtaining IRB approval, we identified 230 patients with sRCC treat ...[more]

PMID: 31590969

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Project description:BackgroundThe preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions.MethodsA total of 1111 patients with EC who had accepted surgical treatment during 2013-2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors.ResultsThe median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83-4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90-3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20-2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54-7.42, P<0.001), showed the highest prognostic value. The Harrell's concordance index of the nomogram was 0.847 (95% CI = 0.804-0.890), showing good discrimination and calibration of this model.ConclusionThe combination of NLR, PLR, and MLR is a superior prognostic factor of EC. The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict OS for EC patients clinically.

Dataset Information

The predictive role of preoperative and postoperative neutrophil-lymphocyte ratio in sarcomatoid renal cell carcinoma.

Publications

The predictive role of preoperative and postoperative neutrophil-lymphocyte ratio in sarcomatoid renal cell carcinoma.

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