The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy

Charles C. Peyton, E. Jason Abel, Juan Chipollini, David C. Boulware, Mounsif Azizi, Jose A. Karam, Vitaly Margulis, Viraj A. Master, Surena F. Matin, Jay D. Raman, Wade J. Sexton, Christopher G. Wood, Philippe E. Spiess

Research output: Contribution to journalArticle

Abstract

Background: The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). Objective: To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). Design, setting, and participants: Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions. Patients were stratified for NLR >4.0 based on cut point analysis. Outcome measurements and statistical analysis: Kaplan-Meier curves compared overall survival of the total cohort and established risk models (Memorial Sloan Kettering Cancer Center [MSKCC], International Metastatic Renal-Cell Carcinoma Database Consortium [IMDC], and M.D. Anderson Cancer Center [MDACC]) stratified by NLR. Multivariable Cox regression determined predictors of overall survival. Receiver operator characteristic curves tested the predictive accuracy of survival ≥12 mo, and area under the curve (AUC) was compared between models. Results and limitations: In total, 332 patients were identified. Patients with NLR ≤4.0 had longer median survival (24.7 vs 15.2 mo, p = 0.004). NLR >4.0 distinguished patients with significantly shorter survival for non-poor-risk groups defined by MSKCC, IMDC, and MDACC criteria. Systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil count, and NLR >4 were independent predictors of decreased survival (p < 0.05). These factors had higher predictive accuracy for survival at 12 mo (AUC = 0.755) than MKSCC, IMDC, and MSKCC models. Conclusions: NLR >4.0 independently predicts poor survival and further distinguishes established risk model survival curves. We identified seven preoperative risk factors related to poor survival for patients with metastatic RCC with tumor thrombus undergoing CN. Patient summary: The neutrophil-lymphocyte ratio and six additional preoperative variables can be used to better council patients regarding survival after surgery for metastatic renal cell carcinoma with tumor thrombus. We identified the neutrophil-lymphocyte ratio and six additional preoperative variables as predictive of worse survival specific to patients with metastatic renal cell carcinoma (mRCC) and tumor thrombus undergoing cytoreductive nephrectomy. The predictive model outperformed established risk predictors of mRCC.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018

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Thrombectomy
Nephrectomy
Neutrophils
Lymphocytes
Survival
Renal Cell Carcinoma
Thrombosis
Neoplasms
Kaplan-Meier Estimate
Lymphocyte Count
L-Lactate Dehydrogenase
Area Under Curve
Hemoglobins

Keywords

  • Carcinoma
  • Mortality
  • Neoplasm metastasis
  • Renal cell
  • Survival
  • Thrombosis

ASJC Scopus subject areas

  • Urology

Cite this

Peyton, C. C., Abel, E. J., Chipollini, J., Boulware, D. C., Azizi, M., Karam, J. A., ... Spiess, P. E. (Accepted/In press). The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy. European Urology Focus. https://doi.org/10.1016/j.euf.2018.08.023

The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy. / Peyton, Charles C.; Abel, E. Jason; Chipollini, Juan; Boulware, David C.; Azizi, Mounsif; Karam, Jose A.; Margulis, Vitaly; Master, Viraj A.; Matin, Surena F.; Raman, Jay D.; Sexton, Wade J.; Wood, Christopher G.; Spiess, Philippe E.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

Peyton, CC, Abel, EJ, Chipollini, J, Boulware, DC, Azizi, M, Karam, JA, Margulis, V, Master, VA, Matin, SF, Raman, JD, Sexton, WJ, Wood, CG & Spiess, PE 2018, 'The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy', European Urology Focus. https://doi.org/10.1016/j.euf.2018.08.023
Peyton, Charles C. ; Abel, E. Jason ; Chipollini, Juan ; Boulware, David C. ; Azizi, Mounsif ; Karam, Jose A. ; Margulis, Vitaly ; Master, Viraj A. ; Matin, Surena F. ; Raman, Jay D. ; Sexton, Wade J. ; Wood, Christopher G. ; Spiess, Philippe E. / The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy. In: European Urology Focus. 2018.
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abstract = "Background: The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). Objective: To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). Design, setting, and participants: Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions. Patients were stratified for NLR >4.0 based on cut point analysis. Outcome measurements and statistical analysis: Kaplan-Meier curves compared overall survival of the total cohort and established risk models (Memorial Sloan Kettering Cancer Center [MSKCC], International Metastatic Renal-Cell Carcinoma Database Consortium [IMDC], and M.D. Anderson Cancer Center [MDACC]) stratified by NLR. Multivariable Cox regression determined predictors of overall survival. Receiver operator characteristic curves tested the predictive accuracy of survival ≥12 mo, and area under the curve (AUC) was compared between models. Results and limitations: In total, 332 patients were identified. Patients with NLR ≤4.0 had longer median survival (24.7 vs 15.2 mo, p = 0.004). NLR >4.0 distinguished patients with significantly shorter survival for non-poor-risk groups defined by MSKCC, IMDC, and MDACC criteria. Systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil count, and NLR >4 were independent predictors of decreased survival (p < 0.05). These factors had higher predictive accuracy for survival at 12 mo (AUC = 0.755) than MKSCC, IMDC, and MSKCC models. Conclusions: NLR >4.0 independently predicts poor survival and further distinguishes established risk model survival curves. We identified seven preoperative risk factors related to poor survival for patients with metastatic RCC with tumor thrombus undergoing CN. Patient summary: The neutrophil-lymphocyte ratio and six additional preoperative variables can be used to better council patients regarding survival after surgery for metastatic renal cell carcinoma with tumor thrombus. We identified the neutrophil-lymphocyte ratio and six additional preoperative variables as predictive of worse survival specific to patients with metastatic renal cell carcinoma (mRCC) and tumor thrombus undergoing cytoreductive nephrectomy. The predictive model outperformed established risk predictors of mRCC.",
keywords = "Carcinoma, Mortality, Neoplasm metastasis, Renal cell, Survival, Thrombosis",
author = "Peyton, {Charles C.} and Abel, {E. Jason} and Juan Chipollini and Boulware, {David C.} and Mounsif Azizi and Karam, {Jose A.} and Vitaly Margulis and Master, {Viraj A.} and Matin, {Surena F.} and Raman, {Jay D.} and Sexton, {Wade J.} and Wood, {Christopher G.} and Spiess, {Philippe E.}",
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T1 - The Value of Neutrophil to Lymphocyte Ratio in Patients Undergoing Cytoreductive Nephrectomy with Thrombectomy

AU - Peyton, Charles C.

AU - Abel, E. Jason

AU - Chipollini, Juan

AU - Boulware, David C.

AU - Azizi, Mounsif

AU - Karam, Jose A.

AU - Margulis, Vitaly

AU - Master, Viraj A.

AU - Matin, Surena F.

AU - Raman, Jay D.

AU - Sexton, Wade J.

AU - Wood, Christopher G.

AU - Spiess, Philippe E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). Objective: To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). Design, setting, and participants: Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions. Patients were stratified for NLR >4.0 based on cut point analysis. Outcome measurements and statistical analysis: Kaplan-Meier curves compared overall survival of the total cohort and established risk models (Memorial Sloan Kettering Cancer Center [MSKCC], International Metastatic Renal-Cell Carcinoma Database Consortium [IMDC], and M.D. Anderson Cancer Center [MDACC]) stratified by NLR. Multivariable Cox regression determined predictors of overall survival. Receiver operator characteristic curves tested the predictive accuracy of survival ≥12 mo, and area under the curve (AUC) was compared between models. Results and limitations: In total, 332 patients were identified. Patients with NLR ≤4.0 had longer median survival (24.7 vs 15.2 mo, p = 0.004). NLR >4.0 distinguished patients with significantly shorter survival for non-poor-risk groups defined by MSKCC, IMDC, and MDACC criteria. Systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil count, and NLR >4 were independent predictors of decreased survival (p < 0.05). These factors had higher predictive accuracy for survival at 12 mo (AUC = 0.755) than MKSCC, IMDC, and MSKCC models. Conclusions: NLR >4.0 independently predicts poor survival and further distinguishes established risk model survival curves. We identified seven preoperative risk factors related to poor survival for patients with metastatic RCC with tumor thrombus undergoing CN. Patient summary: The neutrophil-lymphocyte ratio and six additional preoperative variables can be used to better council patients regarding survival after surgery for metastatic renal cell carcinoma with tumor thrombus. We identified the neutrophil-lymphocyte ratio and six additional preoperative variables as predictive of worse survival specific to patients with metastatic renal cell carcinoma (mRCC) and tumor thrombus undergoing cytoreductive nephrectomy. The predictive model outperformed established risk predictors of mRCC.

AB - Background: The neutrophil-lymphocyte ratio (NLR) is an established signature of inflammation used for evaluating renal cell carcinoma (RCC). Objective: To determine the utility of NLR and its relationship with known risk factors associated with poor survival in patients with metastatic RCC and tumor thrombus undergoing cytoreductive nephrectomy (CN). Design, setting, and participants: Prognostic variables were reviewed for patients undergoing CN with thrombectomy between 2000 and 2014 from six different institutions. Patients were stratified for NLR >4.0 based on cut point analysis. Outcome measurements and statistical analysis: Kaplan-Meier curves compared overall survival of the total cohort and established risk models (Memorial Sloan Kettering Cancer Center [MSKCC], International Metastatic Renal-Cell Carcinoma Database Consortium [IMDC], and M.D. Anderson Cancer Center [MDACC]) stratified by NLR. Multivariable Cox regression determined predictors of overall survival. Receiver operator characteristic curves tested the predictive accuracy of survival ≥12 mo, and area under the curve (AUC) was compared between models. Results and limitations: In total, 332 patients were identified. Patients with NLR ≤4.0 had longer median survival (24.7 vs 15.2 mo, p = 0.004). NLR >4.0 distinguished patients with significantly shorter survival for non-poor-risk groups defined by MSKCC, IMDC, and MDACC criteria. Systemic symptoms, low hemoglobin, elevated lactate dehydrogenase, retroperitoneal adenopathy, level IV thrombus, elevated absolute neutrophil count, and NLR >4 were independent predictors of decreased survival (p < 0.05). These factors had higher predictive accuracy for survival at 12 mo (AUC = 0.755) than MKSCC, IMDC, and MSKCC models. Conclusions: NLR >4.0 independently predicts poor survival and further distinguishes established risk model survival curves. We identified seven preoperative risk factors related to poor survival for patients with metastatic RCC with tumor thrombus undergoing CN. Patient summary: The neutrophil-lymphocyte ratio and six additional preoperative variables can be used to better council patients regarding survival after surgery for metastatic renal cell carcinoma with tumor thrombus. We identified the neutrophil-lymphocyte ratio and six additional preoperative variables as predictive of worse survival specific to patients with metastatic renal cell carcinoma (mRCC) and tumor thrombus undergoing cytoreductive nephrectomy. The predictive model outperformed established risk predictors of mRCC.

KW - Carcinoma

KW - Mortality

KW - Neoplasm metastasis

KW - Renal cell

KW - Survival

KW - Thrombosis

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