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World J Clin Urol. Mar 24, 2018; 7(1): 1-6
Published online Mar 24, 2018. doi: 10.5410/wjcu.v7.i1.1
Neutrophil-lymphocyte ratio in the management and prediction of outcomes in renal cell carcinoma
Tuck Y Yong, Kareeann SF Khow
Tuck Y Yong, Internal Medicine, Flinders Private Hospital, South Australia 5042, Australia
Kareeann SF Khow, Geriatric Training Research and Aged Care Centre, the University of Adelaide, South Australia 5075, Australia
Author contributions: Yong TY and Khow KSF designed, performed the research and wrote the paper.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Tuck Y Yong, FRACP, Internal Medicine, Flinders Private Hospital, Flinders Drive, Bedford Park, South Australia 5042, Australia. tyyong@hotmail.com
Telephone: +61-8-82412121 Fax: +61-8-82400879
Received: October 28, 2017
Peer-review started: October 29, 2017
First decision: November 30, 2017
Revised: December 8, 2017
Accepted: December 28, 2017
Article in press: December 28, 2017
Published online: March 24, 2018
Abstract

Renal cell carcinoma (RCC) is one of the ten most common malignancies. The prognosis of RCC is poor when the disease is in advanced stages, with five-year survival of less than 10%. However current assessment approaches are limited in their ability to prognosticate and guide therapeutic decision-making. Cellular-mediated inflammatory response is increasingly being recognised to have an important role in carcinogenesis of RCC. Various inflammatory markers have been found to identify patients with RCC at high risk of recurrence and predict survival. Neutrophil-lymphocyte ratio (NLR) is a simple and inexpensive inflammatory marker that has been shown to be of value in the assessment of patients with RCC. An elevated pretreatment NLR has been found to be associated with reduced overall survival, recurrence-free survival and progress-free survival and risk of recurrence in localized RCC. In addition, lower pretreatment NLR has been demonstrated to be associated with better clinical response to systemic therapy including vascular endothelial growth factor inhibitors, among patients with metastatic RCC. However, NLR has not been found to differentiate whether small renal masses of less than 40 mm are benign or malignant. Further research is needed to determine the cut-offs for NLR to predict different clinical outcomes and how post-treatment NLR can be used. In addition, more work is also needed to evaluate combining NLR with other biomarkers in a model to predict patients’ clinical outcome or response to treatment for RCC.

Keywords: Neutrophil-lymphocyte ratio, Prognosis, Renal cell carcinoma, Survival

Core tip: Neutrophil-lymphocyte ratio (NLR) is a simple and inexpensive inflammatory marker that is useful in the assessment of patients with renal cell carcinoma (RCC). An elevated pretreatment NLR has been found to be associated with reduced overall, recurrence-free and progress-free survival as well as risk of recurrence in localized RCC. In addition, a lower pretreatment NLR has been demonstrated to be associated with better clinical response to systemic therapy. NLR is a promising marker for risk stratification in RCC and guiding treatment choices.