World Journal of Urology

, Volume 35, Issue 2, pp 261–270 | Cite as

Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients

  • Hong Hu
  • Xiajuan Yao
  • Xiangcheng Xie
  • Xia Wu
  • Chuanming Zheng
  • Wenkai XiaEmail author
  • Shenglin MaEmail author
Original Article



Emerging evidences indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors for improving predictive accuracy in renal cell carcinoma (RCC). We aimed to evaluate the prognostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR) and serum C-reactive protein (CRP) in RCC.


484 surgical RCC patients were enrolled from 2006 to 2010 in this study. Receiver operating curve (ROC) was applied to assess the optimal cutoff levels for four biomarkers, and the prognostic values were determined by Kaplan–Meier curve, univariate and multivariate COX regression models. The predictive accuracy was evaluated by concordance index (c-index).


The median follow-up duration after surgical resection was 36 months. The optimal cutoff levels were 2.78 for NLR, 2.05 for dNLR, 185 for PLR and 5.1 for CRP by ROC curves analysis. Elevated NLR, dNLR, PLR and CRP were significantly correlated with worse overall survival (OS). Multivariate analysis showed that elevated NLR was an independent risk factor for OS, and NLR was superior to dNLR, PLR and CRP based on hazard ratio (HR 2.10, 95 % CI 1.21–3.64, P = 0.008). Additionally, the nomogram could more effectively work in predicting OS (c-index: 0.749) in surgical RCC patients.


Pre-operation NLR can be considered as a potential prognostic biomarker in patients with RCC who underwent surgical resection.


Neutrophil-to-lymphocyte ratio Renal cell carcinoma Survival Prognosis 


Authors’ contribution

MA and XIE developed the protocol; XIA, YAO and ZHENG collected the data; WU and XIA analyzed the data; HU and XIA wrote and edited the manuscript; and HU supervised the project.

Compliance with ethical standards

Conflict of interest


Ethical standards

The study was approved by Medical Ethics Committee of Jiangyin People’s Hospital, Hangzhou First People’s Hospital and Zhejiang Cancer Hospital, respectively.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of NephrologyThe Affiliated Jiangyin Hospital of Southeast University Medical CollegeJiangyinChina
  2. 2.Department of Nephrology, Hangzhou First People’s HospitalHangzhou Hospital Affiliated to Nanjing Medical UniversityHangzhouChina
  3. 3.Department of Head and Neck SurgeryZhejiang Cancer HospitalHangzhouChina
  4. 4.Department of Oncology, Hangzhou First People’s HospitalHangzhou Hospital Affiliated to Nanjing Medical UniversityHangzhouChina

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