Elevated preoperative neutrophil-tolymphocyte ratio may be associated with decreased overall survival in patients with metastatic clear cell renal cell carcinoma undergoing cytoreductive nephrectomy

Objective:Inflammatory serum markers have proven to be a powerful predictive tool of patient prognosis in cancer treatment for a wide variety of solid organ malignancies,predominantly in the context of localized disease.In this study we evaluated the preoperative neutrophil-to-lymphocyte ratio(NLR)as a predictive tool in patients with metastatic clear cell renal cell carcinoma(RCC).Methods:Sixty-four patients with metastatic clear cell RCC undergoing nephrectomy were selected.Only patients with preoperative NLR were included for survival analysis.Patients were categorized into high and low NLR score determined by plotting the NLR ROC curve.Multivariable analysis was performed.Results:Median age was 60.8 years(38.2-81.2).Median follow-up time was 8.1 months(0.1-106.3).Fuhrman grade distribution was:2(3.1%)grade 1,6(9.4%)grade 2,24(37.5%)grade 3 and 32(50.0%)grade 4.Median NLR score was 3.5(1.4-31.0).NLR
4 was associated with decreased overall survival compared toNLR<4(p=0.017).Multivariable survival analysis showed NLR
4 as an independent predictor of survival(Hazard ratio(HR)2.41,95%CI 1.05-5.50,p=0.03).Conclusion:Elevated preoperative NLR is associatedwith poor prognosis in patients withmetastatic kidney cancer.Preoperative NLR is a useful tool,which can predict prognosis,stratify patients for postoperative surveillance,and help guide decisions for therapy.

Major histocompatibility complex I upregulation in clear cell renal cell carcinoma is associated with increased survival

Objective:To examine the prognostic value of tumor major histocompatibility complex I(MHCI)expression on survival and recurrence in patients with clear cell renal cell carcinoma(RCC).Methods:Fifty-three patients that underwent nephrectomy at our institution for clear cell RCC(T1eT3)with
4 years of follow-up were queried from our nephrectomy database.Immunohistochemical staining for MHCI was performed on tumor specimens and MHCI expression was quantified with an automated image analysis technique.Patients were divided into high and low MHCI expression groups in order to study the relationship between MHCI expression and prognosis using the KaplaneMeier method and log-rank test.Results:Overall survival and recurrence free survival were increased in the high MHCI expression group compared to the low MHCI expression group(log-rank,p=0.036 and p=0.028,respectively).Patients alive at the end of the study had higher MHCI expression(mean positivity score 0.82)than those that died of disease(mean positivity score 0.76,t test,p=0.030).Patients that did not develop recurrence during the study period had higher MHCI expression(mean positivity score 0.83)than those that did develop recurrence(mean positivity score 0.78),but this difference was not significant(t test,p =0.079).