Prognostic significance of preoperative neutrophil-to-lymphocyte ratio in papillary renal cell carcinoma patients after receiving curative surgery based on a retrospective cohort
Abstract Background: Inflammatory response biomarkers have been studied as promising prognostic factors in renal cell carcinoma (RCC), but few studies have focused on papillary renal cell carcinoma (PRCC). This study was performed to evaluate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) in PRCC patients. Methods: In total, 90122 postoperative PRCC patients selected from 284 366 non-clear cell renal cell carcinoma (nccRCC) patients were enrolled from our institution between 2012 and 20192020. The optimal cutoff value of the NLR was assessed by receiver operating characteristic (ROC) curve analysis, and the Kaplan–Meier method and Cox's proportional hazards regression models were performed to analyze the association of the NLR with overall survival (OS). In addition, the potential of tumor-node-metastasis (TNM) stage, the NLR and an NLR-TNM system to predict survival were compared with ROC curves. Results: A threshold value of 2.39 for the NLR for OS analysis was determined by ROC curve analysis. An NLR≥2.39 was associated with a more advanced TNM stage (P<0.001) and larger tumors (P<0.05) than a low NLR, as well as pathological subtype Ⅱ (P<0.05), and the patients with a high NLR also exhibited significantly worse overall survival outcomes (P<0.05). The NLR was determined to be a significant independent prognostic indicator by univariable and multivariable analyses (HR = 5.557, P<0.05). Furthermore, TNM stage and the NLR were integrated, and the area under the curve (AUC) of for the NLR-TNM system was larger than that of for the TNM system when predicting overall survival (0.839 VS 0.731, P=0.036). Conclusion: A high preoperative NLR was associated with poor clinical and pathologic parameters in patients with PRCC; moreover, the NLR was also an independent prognostic factor for the OS of patients with PRCC. The NLR-TNM system, which was a model that integrated the NLR with TNM staging, could improve the ability to predict overall survival.