Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis

• Authors: Cathrine Keiner, University of California San Diego; Margaret Meagher, University of California San Diego; Dattatraya Patil, Emory University; Kazutaka Saito, Tokyo Medical and Dental University; Arman Walia, University of California San Diego; Franklin Liu, University of California San Diego; Raksha Dutt, University of California San Diego; Nathan Miller, University of California San Diego; Sohail Dhanji, University of California San Diego; Ava Saidian, University of California San Diego; Fang Wan, Tokyo Medical and Dental University; Yosuke Yasuda, Tokyo Medical and Dental University; Yasuhisa Fujii, Tokyo Medical and Dental University; Hajime Tanaka, Tokyo Medical and Dental University; Viraj Master, Emory University; Ithaar Derweesh, University of California San Diego
• Journal Title: FRONTIERS IN ONCOLOGY
• Volume: Volume 12
• Publisher: FRONTIERS MEDIA SA | 2022-11-24, Pages 995991-995991
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3389/fonc.2022.995991
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; renal cell carcinoma; inflammatory markers; prognostic markers; De Ritis ratio; neutrophil lymphocyte ratio; survival; all-cause mortality; PROGNOSTIC-FACTOR; FOLLOW-UP; SURVIVAL

Abstract

Background: Several markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC. Methods: Multi-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio. Results: 2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis). Elevated NLR was a significant predictor of ACM (HR 1.32, 95% CI: 1.07-1.64, p=0.003) and NCM (HR 1.79, 95% CI: 1.30-2.46, p<0.001) in MVA. Elevated De Ritis was a significant predictor of ACM (HR 2.04, 95% CI: 1.65-2.52), NCM (HR 1.84, 95% CI: 1.33-2.55, p<0.001), and CSM (HR 1.97, 95% CI:1.48-2.63, p<0.001). KMA revealed significant difference in 5-year overall survival (OS) (48% vs. 68%, p<0.001), non-cancer survival (NCS) (69% vs. 87%, p<0.001), and cancer-specific survival (CSS) (60% vs. 73%, p<0.001) for elevated versus non-elevated NLR. For PLR, there was a difference in 5-year OS (51% vs. 61%, p<0.001) and CSS (60% vs. 73%, p<0.001) with KMA. Conclusions: Elevated NLR was independently associated with worse ACM and NCM, while elevated De Ritis was predictive for CSM in addition to ACM and NCM. These differences may be useful in refining risk stratification with respect to cancer-related and non-cancer mortality in RCC patients and deserve further investigation.