Predictive value of preoperative neutrophil-to-lymphocyte ratio in non-metastatic papillary renal cell carcinoma patients after receiving curative surgery

Figures & data

Figure 1 Flow chart of patient selection.

Abbreviations: RCC, renal cell carcinoma; pRCC, papillary renal cell carcinoma; NLR, neutrophil-to-lymphocyte ratio.

Table 1 Demographic and clinicopathologic characteristics of patients with non-metastatic pRCC after partial or radical nephrectomy

Variables	Total (n=76)	NLR <2.5 (n=56)	NLR ≥2.5 (n=20)	p-value
Patients, n (%)	76	56 (73.7%)	20 (26.3%)
Age (mean ± SD)	57.5±12.1	57.5±12.1	57.6±12.5	0.841
Tumor size (mean ± SD)	4.7±2.7	4.4±2.7	5.3±2.6	0.086
Sex, n (%)				0.535
Male	61 (80.3%)	44 (78.6%)	17 (85.0%)
Female	15 (19.7%)	12 (21.4%)	3 (15.0%)
ECOG PS, n (%)				0.576
1	70 (92.1%)	51 (91.1%)	19 (95.0%)
2 or greater	6 (7.9%)	5 (8.9%)	1 (5.0%)
Smoking, n (%)				0.955
No	46 (60.5%)	34 (60.7%)	12 (60.0%)
Yes	30 (39.5%)	22 (39.3%)	8 (40.0%)
Hypertension disease, n (%)				0.158
No	33 (43.4%)	27 (48.2%)	6 (30.0%)
Yes	43 (56.6%)	29 (51.8%)	14 (70.0%)
Diabetes/Hyperglycemia, n (%)				0.771
No	63 (82.9%)	46 (82.1%)	17 (85.0%)
Yes	13 (17.1%)	10 (17.9%)	3 (15.0%)
Dyslipidemia, n (%)				0.646
No	62 (81.6%)	45 (80.4%)	17 (85.0%)
Yes	14 (18.4%)	11 (19.6%)	3 (15.0%)
Hematuria, n (%)				0.939
No	53 (71.6%)	39 (69.6%)	14 (70.0%)
Yes	23 (30.3%)	17 (30.4%)	6 (30.0%)
Anemia, n (%)				0.413
No	65 (85.5%)	49 (87.5%)	16 (80.0%)
Yes	11 (14.5%)	7 (12.5%)	4 (20.0%)
Pathological T stage, n (%)				0.813
T1	57 (75.0%)	42 (75.0%)	15 (75.0%)
T2	9 (11.8%)	6 (10.7%)	3 (15.0%)
T3	10 (13.2%)	8 (14.3%)	2 (10.0%)
Tumor necrosis, n (%)				0.491
No	61 (80.3%)	46 (82.1%)	15 (75.0%)
Yes	15 (19.7%)	10 (17.9%)	5 (25.0%)
Subtype, n (%)^a				0.528
Type I	26 (41.9%)	20 (41.7%)	6 (42.9%)
Type II	32 (51.6%)	24 (50.0%)	8 (57.1%)
Mixed	4 (6.5%)	4 (8.3%)	0 (0.0%)
Fuhrman Grade, n (%)^b				0.260
G2	16 (34.0%)	14 (40.0%)	2 (16.7%)
G3	29 (61.7%)	20 (57.1%)	9 (75.0%)
G4	2 (4.3%)	1 (2.9%)	1 (8.3%)
Surgical type 1, n (%)				0.891
Partial	39 (51.3%)	29 (51.8%)	10 (50.0%)
Radical	37 (48.7%)	27 (48.2%)	10 (50.0%)
Surgical type 2, n (%)				0.297
Minimally invasive	38 (50.0%)	30 (53.6%)	8 (40.0%)
Open	38 (50.0%)	26 (46.4%)	12 (60.0%)

Notes: ^aFourteen patients with no details on tumor subtype. ^bTwenty-nine patients with no details on Fuhrman grade/ungradable.

Abbreviations: pRCC, papillary renal cell carcinoma; ECOG PS, Eastern Cooperative Oncology Group performance status; NLR, neutrophil-to-lymphocyte ratio.

Table 2 Univariate and multivariate Cox regression models to predict DFS for patients of non-metastatic pRCC (T1-3N0M0)

Variables	Univariate analysis		Multivariate analysis
Hazard ratio (95% CI)	p-value	Hazard ratio (95% CI)	p-value
Age (continuous)	1.0 (1.0, 1.0)	0.861	—	—
Age (≥60 vs <60)	0.9 (0.3, 2.9)	0.878	—	—
Sex (female vs male)	0.8 (0.2, 3.8)	0.809	—	—
ECOG PS	1.3 (0.2, 10.5)	0.783	—	—
Smoking	0.5 (0.1, 1.7)	0.246	—	—
Hypertension disease	1.7 (0.5, 5.5)	0.406	—	—
Diabetes/hyperglycemia	2.6 (0.8, 8.7)	0.117	—	—
Dyslipidemia	1.5 (0.4, 5.4)	0.563	—	—
Hematuria	0.7 (0.2, 2.7)	0.636	—	—
Anemia	1.4 (0.3, 6.5)	0.656	—	—
Tumor size (Continuous)	1.2 (1.1, 1.5)	0.008	1.0 (0.9, 1.2)	0.735
Pathological T stage (II-III vs I)	10.1 (2.7, 37.3)	<0.001	6.9 (1.6, 29.7)	0.010
Tumor necrosis	1.4 (0.4, 5.2)	0.608	—	—
Subtype (II vs I)	4.3 (0.5, 37.2)	0.180	—	—
Surgical type 1 (radical vs partial)	5.7 (1.2, 26.1)	0.025	3.3 (0.6, 18.2)	0.166
Surgical type 2 (open vs minimally invasive)	1.2 (0.4, 3.8)	0.758	—	—
Fuhrman Grade (III-IV vs I-II)	2.0 (0.4, 9.5)	0.384	1.5 (0.3, 8.0)	0.623
NLR (≥2.5 vs <2.5)	3.3 (1.1, 10.1)	0.041	3.8 (1.2, 12.5)^a	0.028
			4.1 (1.2, 14.1)^b	0.024

Notes: ^aAdjust for: Age, Sex, Tumor size, Surgical type 1, Pathological T stage. ^bAdjust for Age, Sex, Tumor size, Surgical type 1, Pathological T stage, ECOG PS, Tumor necrosis.

Abbreviations: DFS, disease-free survival; pRCC, papillary renal cell carcinoma; ECOG PS, Eastern Cooperative Oncology Group performance status; NLR,neutrophil-to-lymphocyte ratio.

Figure 2 Kaplan-Meier curves and log-rank test showing patients with high NLR level (≥2.5) had worse DFS compared with those with low NLR level (<2.5) (p=0.03).

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; DFS, disease-free survival.

Table S1 Patient characteristics who recurred following curative surgery

Patient Number	Age/Sex	Tumor Subtype	Fuhrman Grade	Tumor differentiation (Sarcomatoid/Cystic/Calcification/Necrosis)	Tumor Stage	NLR	Recurring Time (months)
1	68/M	II	3	No/No/No/No	T2bN0M0	1.8	28
2	62/M	II	3	No/No/No/Yes	T2bN0M0	3.2	11.8
3	58/M	I	3	No/No/No/No	T3aN0M0	2.8	42
4	57/F	II	3	No/No/No/No	T3aN0M0	1.7	0.7
5	58/F	II	3	No/No/No/Yes	T3bN0M0	1.3	22.4
6	37/F	NA	3	No/No/No/No	T2aN0M0	3.5	10
7	68/F	II	3	No/No/No/Yes	T1aN0M0	3	8.6
8	57/M	I	3	No/No/No/No	T1bN0M0	3.4	3.1
9	66/M	NA	2	No/No/No/No	T2aN0M0	1.5	22.6
10	35/F	II	NA	No/No/No/No	T1bN0M0	2.7	8.5
11	52/F	II	NA	No/No/No/No	T3aN0M0	1.3	24
12	61/M	I	2	No/No/No/No	T3aN0M0	1.9	17

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; M, male; F, female; NA, not available.