The Value Of Preoperative NLR And LMR In The Pathologic And Prognostic Evaluation Of Renal Clear Cell Carcinoma

Background and objective:Renal cell carcinoma is a malignant tumor that occurs in the renal parenchyma.Its the third most common occurrence in the urinary system,behind prostate cancer and bladder cancer.It occurs more frequently in the elderly,and the incidence in men is higher than that in women.In China,the incidence of renal cell carcinoma accounts for 1.56%of adult malignant tumors.The probability of death accounts for 0.83%of adult tumors.Renal clear cell carcinoma(ccRCC)is the most common type of renal cell carcinoma,accounting for approximately 65 to 70%of the total renal cell carcinoma.TNM staging and Fuhrman staging are important factors that can affect the common types of renal cell carcinoma.More and more research evidence indicates that inflammation plays an important role in the development and evolution of tumors.Peripheral blood neutrophil to lymphocyte ratio(NLR)and peripheral blood lymphocyte to monocyte ratio(LMR)before surgery proved to be prognostic factors for different tumors.This study aims to explore the relationship between NLR and LMR and the TNM staging and Fuhrman classification of ccRCC and the application value of NLR and LMR in prognostic evaluation of ccRCC.Methods:The clinical data of 128 patients with CCRCC who underwent radical nephrectomy or partial nephrectomy in our hospital from 2014 to 2015 were retrospectively analyzed.Clinical data were collected,Including gender,age,history of hypertension,history of diabetes,history of smoking;preoperative blood biochemical examination,such as albumin(ALB),creatinine(CRE);routine blood examination,such as hemoglobin(HB),platelet count(PLT),neutrophil,lymphocyte,monocyte The ratio of neutrophil to lymphocyte(NLR),the ratio of lymphocyte to monocyte(LMR),the intraoperative conditions such as operation time,blood loss,etc.,imaging and postoperative pathological features:tumor renal score,tumor Fuhrman pathological grade,tumor TNM pathological stage were calculated.All data were analyzed by spss25.0.The receiver operating curve(ROC)was established to determine the ROC curve,and the best cut-off value of NLR and LMR was determined.The difference of clinical characteristics between NLR group and high NLR group,low LMR group and high LMR group was analyzed byX~2 test.Spearman rank correlation test was used to analyze the correlation between NLR and LMR.Fisher exact probability method was used to analyze the relationship between NLR,LMR and tumor pathological characteristics.Kaplan Meier method was used to calculate the survival rate,and log rank test was used to compare the differences of survival rate between groups.Cox regression analysis was used to determine the independent risk factors for the prognosis of ccrcc.Results:1.There were significant differences between high NLR and low LMR with OS(p<0.001 and p<0.001).High NLR was closely related to high Fuhrman grade(X~2=4.021,p=0.045)and high TNM stage(X~2=3.969,p=0.046);low LMR was related to high renal score(X~2=11.572,p=0.001)and high TNM stage(X~2=9.383,p=0.002).When ccrcc patients were in high NLR and low LMR,the percentage of high TNM stage was 22.2%,which was higher than other groups(p=0.010).2.Univariate analysis showed that NLR,LMR,preoperative albumin,preoperative creatinine,renal score,Fuhrman grade and TNM stage were associated with OS;Cox regression model showed that NLR and LMR were independent prognostic factors of OS in renal clear cell carcinoma(p=0.018,95Cl%:0.128-0.826,HR=0.326;p=0.027,95Cl%:1.148-9.319,HR=3.271).At the same time,TNM stage≥p T3 and Fuhrman grade≥Ⅲwere significantly correlated with the prognosis of RCC.Conclusion:1.In ccrcc patients,preoperative high NLR and low LMR are independent risk factors for tumor prognosis;2.Preoperative high NLR value is closely related to high Fuhrman grade and high TNM stage;preoperative low LMR value is closely related to high renal score and high TNM stage;the combination of the two is helpful to evaluate TNM stage of ccrcc patients.3.TNM stage≥p T3 and Fuhrman grade≥Ⅲ were significantly correlated with the prognosis of renal clear cell carcinoma.