Tumor Biology

, Volume 37, Issue 4, pp 4613–4620 | Cite as

Prognostic value of preoperative lymphocyte to monocyte ratio in patients with nonmetastatic clear cell renal cell carcinoma

  • Yuan Chang
  • Qiang Fu
  • Le Xu
  • Lin Zhou
  • Zheng Liu
  • Yuanfeng Yang
  • Zongming Lin
  • Jiejie Xu
Original Article


Growing evidence indicates that systemic inflammation involves in cancer development and progression. Preoperative lymphocyte to monocyte ratio (LMR) has been estimated as an independent prognostic factor of various cancers. We investigated the prognostic value of LMR in nonmetastatic clear cell renal cell carcinoma (ccRCC) patients after surgery. We retrospectively recruited 430 consecutive patients with nonmetastatic ccRCC (T1-3N0M0) who underwent curative nephrectomy between 2008 and 2009 at a single center in China. Lymphocyte and monocyte counts were obtained at hospitalization before surgery. Preoperative LMR as a continuous variable and as a dichotomized variable at a level of 3.25, which was the 25th percentile value, were analyzed in unvariable and multivariable Cox regression models, respectively. Concordance index (C-index) was calculated to assess predictive accuracy. Kaplan-Meier method was applied to compare survival curves. As both of the continuous and dichotomized variable, decreased preoperative LMR was proven to be independent prognostic factors of recurrence-free survival (P = 0.039 and P = 0.003, respectively) and overall survival (P = 0.002 and P < 0.001, respectively). Further examination revealed that the dichotomized LMR could enhance the predictive accuracy of each of the existing prognostic models among intermediate-risk to high-risk patients. The preoperative LMR is an independent prognostic factor of recurrence-free survival and overall survival for nonmetastatic ccRCC patients after surgery, and it can be used in tandem with established prognostic systems to further enhance outcome prediction in intermediate-risk to high-risk patients.


Renal cell carcinoma Inflammation Biomarker Overall survival Recurrence-free survival 



This study was funded by grants from the National Natural Science Foundation of China (31100629, 31270863, 81372755, 81471621, 81472227, 81402082, 81402085), Program for New Century Excellent Talents in University (NCET-13-0146), and Shanghai Rising-Star Program (13QA1400300). All these study sponsors have no roles in the study design, in the collection, analysis, and interpretation of data.

Compliance with ethical standards

Conflicts of interest


Supplementary material

13277_2015_4300_MOESM1_ESM.docx (19 kb)
Table S1 Univariate and multivariate cox regression analyses for recurrence-free survival and overall survival (DOCX 19 kb)
13277_2015_4300_Fig3_ESM.jpg (106 kb)
Figure S1

Kaplan-Meier curves for recurrence-free survival (A–B) and overall survival (C–D) among patients classified as UISS score in low-risk (1 score) and intermediate-risk (2 score) or high-risk level (≥3 score). UISS, the University of California Los Angeles Integrated Staging System (JPEG 105 kb)

13277_2015_4300_MOESM2_ESM.tif (6.4 mb)
High Resolution Image (TIFF 6593 kb)
13277_2015_4300_Fig4_ESM.jpg (117 kb)
Figure S2

Kaplan-Meier curves for recurrence-free survival (A–B) and overall survival (C–D) among patients classified as SSIGN score in low-risk (0–2 score) and intermediate-risk (3–6 score) or high-risk level (≥7 score). SSIGN, the Mayo Clinic stage, size, grade, and necrosis (JPEG 116 kb)

13277_2015_4300_MOESM3_ESM.tif (6.9 mb)
High Resolution Image (TIFF 7092 kb)


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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  1. 1.Department of Urology, Zhongshan HospitalFudan UniversityShanghaiChina
  2. 2.Department of Biochemistry and Molecular Biology, School of Basic Medical SciencesFudan UniversityShanghaiChina
  3. 3.Department of Urology, Ruijin Hospital, School of MedicineShanghai Jiaotong UniversityShanghaiChina

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