Neutrophil-Lymphocyte Ratio in Small Renal Masses

Introduction. To evaluate the association between preoperative neutrophil-lymphocyte ratio (NLR) and clinicopathologic characteristics in patients with small renal masses (SRM). Methods. Retrospective chart reviews of patients with renal masses ≤4？cm who underwent nephrectomy from January 2007 to July 2012 were conducted. Multivariable linear regression was used to examine the association between preoperative NLR and clinicopathologic variables. Results. In 1001 patients, we noted higher mean preoperative NLR in men ( versus in women, ) and Caucasians ( versus in African Americans, ) but no significant differences in patients with low (I-II) versus high (III-IV) American Society of Anesthesiologists (ASA) scores ( versus , ) or benign versus malignant pathology ( versus , ). Spearman correlation analysis ( ) showed preoperative NLR significantly correlated with age ( , ) and preoperative serum creatinine (Crea) [ , ]. On multivariable linear regression analysis older age, male gender, Caucasian race, and preoperative Crea were predictive of higher preoperative NLR, but ASA score and tumor pathology were not. Conclusions. In patients with SRM, we found no association between preoperative NLR and tumor pathology. 1. Introduction In 1863 Virchow proposed a relationship between inflammation and malignancy. There is now an ample body of literature on the association between chronic inflammation and cancer [1–4], with an estimated 15% of malignancies worldwide being reported as having an infectious association or etiology [5]. C-reactive protein (CRP), a serum marker for systemic inflammation, has shown good prognostication in patients with renal cell carcinoma (RCC) [6–10] and similar findings when combined with serum albumin levels in the modified Glasgow Prognostic Score [3]. However, CRP requires additional serum testing and hence is not readily available for all patients. Neutrophil-lymphocyte ratio (NLR) is easily calculated by dividing the absolute neutrophil count by the absolute lymphocyte count from a complete blood count with differential, and its rise is a result of simultaneous increase in circulating neutrophils and decrease in lymphocytes with systemic inflammation [11]. NLR has been reported to correlate well with serum CRP levels [12] and to predict oncological outcomes in patients with RCC [12], nonclear cell RCC [13], and upper tract urothelial cell carcinoma [14]. The objective of our study was to explore for an association between preoperative NLR and age, gender, race, renal function, and tumor pathology in patients who underwent