Preoperative neutrophil-lymphocyte ratio (NLR) may predict survival following cytoreductive nephrectomy plus thrombectomy for renal cell carcinoma (RCC), a new study suggest.

In a study involving 332 patients with metastatic RCC and tumor thrombus, patients with a preoperative NLR above 4 had significantly shorter median overall survival (OS) than those with an NLR of 4 or below (15.2 vs 24.7 months), Charles C. Peyton, MD, of Moffitt Cancer Center in Tampa, Florida, and colleagues reported online ahead of print in European Urology Focus.

An NLR of 4 or below was associated with a significant survival benefit only among patients not classified as poor risk according to 3 previously established classification schemes: the Memorial Sloan Kettering Cancer Center (MSKCC), International Metastatic Renal-Cell Carcinoma Database (IMDC), and MD Anderson Cancer Center (MDACC) models. Among MSKCC, IMDC, and MDACC non-poor-risk patients, those with an NLR of 4 or below had a median 10.9-, 10.9-, and 11.2-month longer OS, respectively, than those with an NLR above 4.

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In addition to an NLR above 4, other independent preoperative predictors of decreased survival included systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil counts, according to the investigators.

Median OS was 40.9 months among patients with none of these identified risk factors, compared with 33.7, 29.6, 14.2, 8.8, 3.1, and 1.2 months among those with 1, 2, 3, 4, 5, and 6 risk factors, respectively. Compared with patients with no risk factors, those with 3, 4, 5, and 6 risk factors had a significant 2.3, 3.9, 4.7, and 10.6 times higher risk of death, respectively, Dr Peyton’s team reported. These risk factors more accurately predicted survival at 12 months compared with the MSKCC, IMDC, and MDACC models for patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy with thrombectomy.

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Of the 332 patients, 157 (47%) had an NLR above 4.0. Median follow-up time was 14.4 months. Median OS was 21.1 months for the entire cohort.


Peyton CC, Abel EJ, Chipollini J, et al. The value of neutrophil to lymphocyte ratio in patients undergoing cytoreductive nephrtectomy with thrombectomy. Eur Urol Focus. 2018; published online ahead of print.