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Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma

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Abstract

Purpose

Pretreatment measurements of systemic inflammatory response, including the Glasgow prognostic score (GPS), the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) and the prognostic nutritional index (PNI) have been recognized as prognostic factors in clear cell renal cell carcinoma (CCRCC), but there is at present no study that compared these markers.

Methods

We evaluated the pretreatment GPS, NLR, MLR, PLR and PNI in 430 patients, who underwent surgery for clinically localized CCRCC (pT1-3N0M0). Associations with disease-free survival were assessed with Cox models. Discrimination was measured with the C-index, and a decision curve analysis was used to evaluate the clinical net benefit.

Results

On multivariable analyses, all measures of systemic inflammatory response were significant prognostic factors. The increase in discrimination compared with the stage, size, grade and necrosis (SSIGN) score alone was 5.8 % for the GPS, 1.1–1.4 % for the NLR, 2.9–3.4 % for the MLR, 2.0–3.3 % for the PLR and 1.4–3.0 % for the PNI. On the simultaneous multivariable analysis of all candidate measures, the final multivariable model contained the SSIGN score (HR 1.40, P < 0.001), the GPS (HR 2.32, P < 0.001) and the MLR (HR 5.78, P = 0.003) as significant variables. Adding both the GPS and the MLR increased the discrimination of the SSIGN score by 6.2 % and improved the clinical net benefit.

Conclusions

In patients with clinically localized CCRCC, the GPS and the MLR appear to be the most relevant prognostic measures of systemic inflammatory response. They may be used as an adjunct for patient counseling, tailoring management and clinical trial design.

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Acknowledgments

IL is supported by the development fund of the CHUV-University Hospital. TK is supported by funds of the Oesterreichische Nationalbank (Anniversary Fund, Project Number: 15362).

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee, and all patients included gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Department of Urology, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Ilaria Lucca, Michela de Martino, Sebastian L. Hofbauer, Nura Zamani, Shahrokh F. Shariat & Tobias Klatte

  2. Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland

    Ilaria Lucca

Authors
  1. Ilaria Lucca
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  2. Michela de Martino
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  3. Sebastian L. Hofbauer
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  4. Nura Zamani
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  5. Shahrokh F. Shariat
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  6. Tobias Klatte
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Corresponding author

Correspondence to Tobias Klatte.

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Lucca, I., de Martino, M., Hofbauer, S.L. et al. Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma. World J Urol 33, 2045–2052 (2015). https://doi.org/10.1007/s00345-015-1559-7

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  • DOI: https://doi.org/10.1007/s00345-015-1559-7

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