Preoperative Prognostic Nutritional Index And Neutrophil-to-Lymphocyte Ratio In Predicting Postoperative Recurrence In Patients With Non-metastatic Clear Cell Renal Cell Carcinoma

Objective: To explore the predictive value of preoperative prognostic nutritional index(PNI)and neutrophil-to-lymphocyte ratio(NLR)in postoperative recurrence in patients with non-metastatic clear cell renal cell carcinoma(cc RCC).Research Objects and Methods: The clinicopathological data of 381 patients with non-metastatic clear cell renal cell carcinoma who underwent partial nephrectomy or radical nephrectomy in our hospital from January 2010 to December 2015 were retrospectively analyzed.The optimal cut-off values of preoperative PNI and NLR were determined by receiver operator characteristic curve,which were divided into high and low groups,and the relationship between preoperative PNI and NLR and clinicopathological characteristics of patients was analyzed.The univariate and multivariate Cox proportional hazards models were used to explore the independent prognostic factors for recurrence-free survival in patients with non-metastatic clear cell renal cell carcinoma.The Kalpan-Meier survival method was used to analyze the influence of PNI and NLR on the recurrence-free survival,and the subgroup survival analysis was carried out according to age,pathological T stage and Fuhrman grade.Results:(1)The optimal cut-off values of preoperative PNI and NLR were determined by receiver operator characteristic curve: high-PNI group(PNI>46.63)and low-PNI group(PNI≤46.63),high-NLR(NLR>2.95)and low-NLR(NLR≤2.95).(2)Lower preoperative PNI was significantly associated with older age(P=0.027),anemia(P=0.001),higher pathological T stage(P=0.009),and higher Fuhrman grade(P=0.010).Higher preoperative NLR was significantly associated with older age(P=0.006),anemia(P=0.042),larger tumor diameter(P=0.029),higher pathological T stage(P=0.001),and higher Fuhrman grade(P=0.010).(3)The preoperative PNI(HR=0.914,95%CI 0.855-0.978,P=0.009)and NLR(HR=1.332,95%CI 1.033-1.719,P=0.027)were independent predictors of recurrence-free survival in patients with cc RCC.(4)Subgroup survival analysis showed that the postoperative recurrence-free survival of patients in the low-PNI group was significantly shorter than that in the highPNI group,both in the elderly(P<0.0001)and the young(P<0.0001).The postoperative recurrence-free survival of patients in the low-PNI group was significantly shorter than that in the high-PNI group,regardless of the pathological T1 and T2 stage(P<0.0001)or pathological T3 and T4 stage(P=0.008).The postoperative recurrence-free survival of patients in the low-PNI group was significantly shorter than that in the high-PNI group,regardless of the Fuhrman gradeⅠandⅡ(P<0.0001)or Fuhrman grade Ⅲ andⅣ(P<0.0001).The postoperative recurrence-free survival of patients in the high-NLR group was significantly shorter than that in the low-NLR group,both in the elderly(P<0.0001)and the young(P<0.0001).The postoperative recurrence-free survival of patients in the high-NLR group was significantly shorter than that in the low-NLR group,regardless of the pathological T1 and T2 stage(P<0.0001)or pathological T3 and T4 stage(P=0.0012).The postoperative recurrence-free survival of patients in the high-NLR group was significantly shorter than that in the low-NLR group,regardless of the Fuhrman gradeⅠandⅡ(P<0.0001)or Fuhrman grade Ⅲ and Ⅳ(P<0.0001).(5)Combining preoperative PNI and NLR to predict postoperative recurrence-free survival of patients with non-metastatic clear cell renal cell carcinoma,the area under the curve(AUC=0.800)is significantly better than using PNI(AUC=0.769)or NLR(AUC=0.741)alone.Conclusion: The preoperative PNI and NLR can be used as independent predictors of recurrence-free survival in patients with non-metastatic clear cell renal cell carcinoma undergoing nephrectomy.The combination of preoperative PNI and NLR can better predict postoperative recurrence-free survival in patients with non-metastatic clear cell renal cell carcinoma.Therefore,the preoperative PNI and NLR may be useful indicators for predicting recurrence in these patients.