Utility of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio in Predicting Malignancy in Patients with Small Renal Mass

Abstract

Background: Abdominal imaging has become increasingly prevalent, resulting in the incidental detection of renal tumors. The majority of small renal masses (SRMs), which are surgically removed, prove to be malignant. However, some cases turn out to be benign, which can lead to unnecessary surgeries with associated significant morbidity. Recently, many inflammatory biomarkers have shown to be promising prognostic factors in RCC. We aimed to assess the importance of inflammatory biomarkers, which are simple and economical, in SRMs. Objective: We investigated whether preoperative neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) can predict malignancy in patients with SRMs. Material and Methods: A retrospective analysis was performed on 108 patients who underwent partial or radical nephrectomy for SRMs (tumors smaller than 4 cm) from January 2016 to December 2022. The patients were classified into two groups based on their histopathological diagnosis: benign group (n = 28) and malignant group (n = 80). NLR and PLR values were assessed for sensitivity using the ROC curve. Independent t-test, Mann–Whitney test, and Chi-square test were utilized. P <0.05 indicated statistical significance. Results: The mean age of patients was 58.9 ± 12.3 years in the benign group and 53.3 ± 11.9 years in the malignant group (P = 0.03). The mean tumor size was 3.26 ± 0.52 cm in the benign group and 3.04 ± 0.90 cm in the malignant group (P = 0.60). NLR (P = 0.008) and PLR (P ≤ 0.001) values were significantly higher in the malignant group (median: 3.65 and 201) compared to the benign group (median: 2.82 and 125), respectively. The area under a ROC curve was 0.669 (P = 0.002) and 0.758 (P < 0.001), with sensitivity values of 62.5% and 87.5%, specificity of 64.29% and 57.14%, and cutoff points of 3.45 and 130.21, for NLR and PLR, respectively. Conclusion: NLR and PLR can be considered biomarkers for predicting malignancy in SRMs. NLR and PLR should be included in a patient’s clinical evaluation along with imaging studies and overall health status.

Keywords

• inflammatory markers
• malignancy
• nlr
• plr
• renal cell carcinoma
• small renal mass