Pretreatment Lymphocyte to Monocyte Ratio is an Independent Prognostic Factor in Metastatic Clear Cell Renal Cell Carcinoma.

BACKGROUND: The prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in metastatic clear cell renal cell carcinoma (ccRCC) is not well-described. The purpose of this study was to assess the prognostic role of pretreatment LMR in surgically treated metastatic ccRCC.

PATIENTS AND METHODS: One hundred forty-five patients with metastatic ccRCC who underwent cytoreductive nephrectomy between 2006 and 2013 at our institute were identified. Pretreatment LMR was calculated within 1 week before surgical intervention. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method. Pretreatment LMR, as a continuous variable and as a dichotomized variable at a cutoff of 3.0, were analyzed in univariable and multivariable Cox regression models, respectively. Moreover, the impact of the LMR on the predictive accuracy of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) models was evaluated using the Harrell concordance index (C-index).

RESULTS: Decreased LMR was statistically correlated with some clinicopathologic characteristics that are indicative of disease aggressiveness and poor prognosis. As both the continuous and dichotomized variable, decreased pretreatment LMR was demonstrated to be independently associated with poorer PFS (P = .041 and P < .001, respectively) and OS (P = .014 and P < .001, respectively). Further study indicated that the dichotomized LMR could improve the predictive accuracy of the IMDC and MSKCC models.

CONCLUSION: Pretreatment LMR appears to be an independent prognostic factor of PFS and OS for patients with metastatic ccRCC after surgery, and it can be utilized to enhance the predictive ability of well-established prognostic models.