The Affect of Preoperative Neutrophil-Lymphocyte Ratio on Distant Metastasis and Disease Specific Survival in Patients Who Underwent Nephrectomy for Localized Renal Cell Carcinoma

Abstract

INTRODUCTION: In this study, we aimed to evaluate the effects of pre-nephrectomy Neutrophil-Lymphocyte ratio (NLR) on development of distant metastasis and disease specific survival (DSS). METHODS: The data of 780 patients who underwent radical or partial nephrectomy for localized renal cell carcinoma (RCC) between January 1995 and December 2014 was evaluated retrospectively. The demographics, pathologic stage, histological type of tumor, tumor grade were recorded. Furthermore, data of white blood cell, platelet, neutrophil, lymphocyte counts and NLR (level within 14 days before nephrectomy) were recorded. Primary endpoints of this study were distant metastasis development and DSS. RESULTS: For all patients mean age was 58.4+-12. During median 44 months follow-up period, distant metastasis developed in 210 (26.9%) patients and death occurred due to RCC in 132 (16.9%) patients. High NLR levels (NLR≥4) were related to higher Fuhrmann tumor grade, advanced tumor stage, distant metastasis development and disease specific mortality (for all comparisons p<0.001). On multivariate analysis, Fuhrmann tumor grade 3-4, pathological stage 3-4 and NLR≥4 were found as independent predictive factor to predict metastasis development. To predict DSS, pathological stage 3-4 and NLR≥4 were found as independent predictive factor. DISCUSSION AND CONCLUSION: High NLR associated with high risk of metastasis development and DSS. However, multicenter and prospective trials are needed to support our results.

Keywords

• kidney tumor
• metastasis
• neutrophil-lymphocyte ratio
• survival