Elevated neutrophil-lymphocyte ratio (NLR) alone and in combination with hyponatremia at the time of diagnosis and recurrence of renal cell carcinoma (RCC) are associated with a poor prognosis, new data suggest.

At RCC diagnosis, patients with an NLR above 3.0 had a significant 1.8-fold increased risk of death compared with those who had an NLR of 3.0 or less in adjusted analyses, Maria Møller Pedersen, MD, of Aarhus University Hospital in Aarhus, Denmark, and her collaborators reported in Acta Oncologica. Patients with an NLR above 3.0 and concomitant hyponatremia had a significant 2.8-fold increased risk of death compared with those who had an NLR of 3.0 or lower and normal sodium levels. At RCC recurrence, patients with an NLR above 3.0 and hyponatremia had a 3.6-fold increased risk of death compared with those who had an NLR of 3.0 or less and no hyponatremia. For all of these associations, investigators adjusted for age, sex, stage, Charlson Comorbidity Index, C-reactive protein, calcium, albumin, serum sodium, LDH, hemoglobin, and platelets.

Dr Pedersen’s team noted that NLR and sodium level measurements are “readily available, at low cost, and may thus serve as cost-effective markers for prognostic prediction; they have the potential to be easily incorporated in prognostic models to optimize outcome prediction.”

The authors said their study “is the first to follow the same cohort of patients from localized RCC diagnosis to recurrence, and to demonstrate the poorer prognosis of combined NLR-hyponatremia measurement at both time points.”

The study included 970 patients with RCC with a median age of 66.6 years. All had NLR and sodium values measured within 30 days of diagnosis. A total of 411 patients had an NLR of 3.0 or less and 559 had an NLR above 3.0. In addition, 240 patients had hyponatremia and 730 had normal sodium values.

The 5-year survival rate was 35.2% among patients with an NLR above 3.0 compared with 69.2% among those with an NLR of 3.0 or less, Dr Pedersen and her collaborators reported. The 5-year survival rate was 21.7% for patients who had an NLR above 3.0 and concomitant hyponatremia compared with 73.2% for those with an NLR of 3.0 or less and normal sodium levels.

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Of the 442 patients who underwent surgery for localized RCC, 76 (17.2%) had RCC recurrence within 3 years of follow-up. Fifty-eight of these patients had NLR and sodium levels measured at the time of recurrence. Eleven patients had an NLR above 3.0 and hyponatremia and 29 had an NLR of 3.0 of less and no hyponatremia.

Reference

Pedersen MM, Donskov F, Pedersen L, et al. Elevated neutrophil-lymphocyte ratio combined with hyponatremia indicate poor prognosis in renal cell carcinoma [published online August 26, 2019]. Acta Oncol. doi: 10.1080/0284186X.2019.1654128