Evaluation of role of inflammatory markers for the prediction of recurrence on pathologic T1a clear cell renal cell cancer patients

Abstract

Objective: To evaluate the role of neutrophil to lymphocyte ratio (NLR), high sensitive C-reactive protein (hs-CRP) and procalcitonin levels in the prediction of tumor recurrence in stage T1aN0M0 clear cell renal cell carcinoma (RCC). Materials and Methods: We assessed 400 patients pathologically staged as T1aN0M0 clear cell RCC after radical or partial nephrectomy, in two institutions, between January 2007 and March 2014. Data of demographics, neutrophil and lymphocyte counts, NLR, hs-CRP, procalcitonin levels, tumor size, Fuhrmann nuclear grade and disease recurrence were collected. The primary outcome measure of this study was the evaluation of the relationship between NLR, hs-CRP and procalcitonin levels with recurrence free survival. Results: The mean age and the mean tumor size of the patients were 56.8 +/- 13.1 years and 29.3 +/- 7.7 mm, respectively. Mean NLR, hs-CRP and procalcitonin levels were 3.2 +/- 2.6, 0.822 +/- 0.404 mg/L and 0.088 +/- 0.05 ng/mL, respectively. Fuhrmann Grade 1-2 and Fuhrmann Grade 3-4 tumor were observed in 76% and 24% of total patients, respectively. The mean follow up of the patient was 32.8 months. Totally tumor recurrence was detected in 5 patients. The receiver-operating characteristic analysis revealed cut off values of 4.50 for the NLR, 0.655 mg/L for hs-CRP and 0.078 ng/mL for and procalcitonin levels. In the multivariate analysis, the Fuhrmann grade 3-4 (p=0.017) and NLR values >= 4.50 (p=0.025) were detected to be associated with increased risk of recurrence. Conclusions: High preoperative NLR value may be associated with increased risk of recurrence in stage pathologic T1a RCC patients. Studies with longer duration of follow up, prospective and larger populations are needed.