Prognostic Significance of Inflammation-Associated Blood Cell Markers in Nonmetastatic Clear Cell Renal Cell Carcinoma - Beyond the Abstract

Inflammation has been implicated in carcinogenesis, with several studies demonstrating the relationship between cancer and elevated inflammatory markers. These inflammatory markers serve as cost-effective and easily obtainable biomarkers that could be used for the prognostication of cancer. Inflammation-related parameters such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and red blood cell distribution width (RDW) have all been shown to be associated with prognostication in clear cell renal cell carcinoma (ccRCC).

In our study, we investigated the association between the preoperative inflammation-related blood markers with the clinicopathologic characteristics and survival outcomes of 687 patients with nonmetastatic ccRCC who had undergone nephrectomy with curative intent with a  median follow-up duration of 76.3 months. On a multivariate analysis including neutrophil-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and red cell distribution width (RDW), only platelet-lymphocyte ratio (PLR) remained a robust independent prognostic marker for both cancer-specific survival (CSS) (hazard ratio [HR], 2.69; 95% confidence interval [CI], 1.36-5.33; p=0.004) and overall survival (OS) (HR, 2.19; 95% CI, 1.36-3.50; p=0.001). When PLR was included with the Leibovich score and UISS, the c-index increased from 0.854 to 0.876 and 0.751 to 0.810, respectively, for CSS at five years after nephrectomy. PLR also remained an independent predictor of CSS, after adjusting for the Leibovich and UISS risk groups

Our analyses have demonstrated that PLR is a robust prognostic marker in nonmetastatic ccRCC and clearly outperformed other inflammatory indexes in our cohort of patients who had undergone nephrectomy. Moreover, our study was able to demonstrate that a high PLR did not have a prognostic impact on lower pathologic tumor stage (pT1a) and, correspondingly, low-risk ccRCC. To the best of our knowledge, our analysis is the first to highlight this distinction. With the findings from our study, clinicians might be better able to predict the survival outcomes of nonmetastatic ccRCC using PLR and should consider the inclusion of PLR in the development of prognostic models in the future.

Written by: Dr. Alvin Lee, Department of Urology, Singapore General Hospital, Singapore.

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