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Pre-treatment neutrophil-to-lymphocyte ratio predicts tumor pathology in newly diagnosed renal tumors

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 19 May 2016

Abstract

Purpose

The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes after surgical treatment for clear cell renal cell carcinoma (ccRCC). However, its ability to distinguish aggressive from indolent renal tumors remains unknown. We therefore evaluated the association between NLR and pathologic outcomes at nephrectomy.

Methods

From 1995 to 2008, 2402 patients underwent radical or partial nephrectomy for localized renal tumors. Of these, 2039 had an NLR within 90 days prior to surgery. Comparisons of NLR by tumor size, histologic subtype, and nuclear grade were evaluated.

Results

Benign renal masses had a significantly lower NLR than malignant tumors (median 2.92 vs. 3.12; p = 0.037) with the greatest difference noted among renal lesions >7 cm (median 2.79 vs. 3.87; p < 0.001). There was a significant difference in NLR among RCC subtypes (p = 0.002), with cystic ccRCC demonstrating the lowest (median 2.48) and collecting duct RCC the highest NLR (median 5.99). Moreover, there was a significant increase in NLR with larger tumor size and greater nuclear grade (p < 0.001). Specifically, in patients with ccRCC, an incremental increase in tumor size (≤4 cm = 2.80, >4 but ≤7 cm = 3.09 and >7 cm = 3.95) and nuclear grade (G1 = 2.68, G2 = 2.87, G3 = 3.48, and G4 = 5.18) was associated with greater NLR (p < 0.001).

Conclusions

An elevated NLR is associated with RCC pathology, higher-grade tumors, and more aggressive histologic subtypes at the time of nephrectomy. Therefore, NLR appears to be a preoperative marker of biologically aggressive RCC and may be useful in predicting malignancy and guiding management among patients with suspicious renal tumors.

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Author’s contribution

B.R. Viers, R.H. Thompson, S.A. Boorjian, and M.K. Tollefson were involved in protocol/project development and manuscript writing/editing. C.M. Lohse was involved in data collection or management, and data analysis. J.C. Cheville was involved in data collection or management, and manuscript writing/editing. B.C. Leibovich was involved in manuscript writing/editing.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    Boyd R. Viers, R. Houston Thompson, Bradley C. Leibovich, Stephen A. Boorjian & Matthew K. Tollefson

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Christine M. Lohse

  3. Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA

    John C. Cheville

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  1. Boyd R. Viers
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Correspondence to Matthew K. Tollefson.

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The corresponding author has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Each of the authors has made a substantial contribution to the material submitted here, and all authors have read and approved the manuscript. This manuscript is not under consideration by another journal or electronic publication, nor has it been previously published.

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Viers, B.R., Thompson, R.H., Lohse, C.M. et al. Pre-treatment neutrophil-to-lymphocyte ratio predicts tumor pathology in newly diagnosed renal tumors. World J Urol 34, 1693–1699 (2016). https://doi.org/10.1007/s00345-016-1821-7

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  • DOI: https://doi.org/10.1007/s00345-016-1821-7

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