Neutrophil-lymphocyte ratio in the management and prediction of outcomes in renal cell carcinoma

Renal cell carcinoma(RCC) is one of the ten most common malignancies.The prognosis of RCC is poor when the disease is in advanced stages,with five-year survival of less than 10%.However current assessment approaches are limited in their ability to prognosticate and guide therapeutic decision-making.Cellular-mediated inflammatory response is increasingly being recognised to have an important role in carcinogenesis of RCC.Various inflammatory markers have been found to identify patients with RCC at high risk of recurrence and predict survival.Neutrophil-lymphocyte ratio(NLR) is a simple and inexpensive inflammatory marker that has been shown to be of value in the assessment of patients with RCC.An elevated pretreatment NLR has been found to be associated with reduced overall survival,recurrence-free survival and progress-free survival and risk of recurrence in localized RCC.In addition,lower pretreatment NLR has been demonstrated to be associated with better clinical response to systemic therapy including vascular endothelial growth factor inhibitors,among patients with metastatic RCC.However,NLR has not been found to differentiate whether small renal masses of less than 40 mm are benign or malignant.Further research is needed to determine the cut-offs for NLR to predict different clinical outcomes and how post-treatment NLR can be used.In addition,more work is also needed to evaluate combining NLR with other biomarkers in a model to predict patients' clinical outcome or response to treatment for RCC.

Relationship between perioperative anaemia and outcomes in older people with hip fractures: A systematic review and meta-analysis protocol

BACKGROUND Hip fractures are common with increasing age and is associated with decline in mobility. Both the fracture and the surgery can lead to blood loss, resulting in anaemia. However, it is uncertain at which time point haemoglobin is most strongly associated with different clinical outcomes after hip fracture. Our hypothesis is perioperative anaemia (admission, postoperative and discharge) during hip fracture surgery is associated with poor clinical outcomes. AIM To determine the effects of perioperative anaemia during hip fracture surgery on mortality, functional status and other clinical outcomes. METHODS Electronic databases will be searched to identify studies evaluating perioperative anaemia and outcomes of hip fracture surgery. Reference lists of included studies will also be searched to identify additional published studies. Eligibility criteria are as follows: Population: People who underwent hip fracture surgery;Exposure: Perioperative anaemia;Comparison: No anaemia before or after hip fracture surgery;Outcome: Mortality, hospital length of stay, postoperative complications, hospital readmission, change of discharge destination, quality of life and functional status. Risk of bias assessment will be assessed using the Cochrane Collaboration’s tool for randomized controlled trials and the modified version of the Epidemiological Appraisal Instrument for observational studies. Data will be pooled for meta-analysis if deemed appropriate. CONCLUSION This review seeks to clarify outcomes associated with perioperative anaemia at various time-points around hip fracture surgery. These findings will potentially inform evidence-based clinical practice on interventions in those with anaemia.

Chronic kidney disease after radical nephrectomy for suspected renal cancers

Nephrectomy is the treatment of choice for early stage renal cell carcinoma. However,radical nephrectomy is consistently associated with higher rates of newonset chronic kidney disease(CKD) than the general population,regardless of the method used in measuring renal function. The higher rates of CKD are associated with worsened survival because of increased risk of cardiovascular diseases and mortality. Comorbidities and adjacent non-neoplastic kidney diseases are important risk factors for the development of CKD after nephrectomy. Partial nephrectomy has become the standard of care for patients with stage 1a tumours(diameter < 4 cm) and an attractive option for those with stage 1b(diameter 4-7 cm). Therefore stratifying the risk of postoperative CKD before surgery is important and ongoing monitoring of kidney function after radical nephrectomy is needed in addition to oncological surveillance. More research is needed to better understand the risk of CKD after radical nephrectomy and develop effective strategies to optimize kidney function after such surgery.