Prognostic significance of lymphocyte-to-monocyte ratio and CRP in patients with nonmetastatic clear cell renal cell carcinoma: a retrospective multicenter analysis

Wen-Kai Xia, Xia Wu, Tang-Hong Yu, Yu Wu, Xia-Juan Yao, Hong Hu, Wen-Kai Xia, Xia Wu, Tang-Hong Yu, Yu Wu, Xia-Juan Yao, Hong Hu

Abstract

Background: Inflammation has been reported to be involved in carcinogenesis and cancer progression. This study was designed to explore the prognostic significance of lymphocyte-to-monocyte ratio (LMR) and serum C-reactive protein (CRP) in nonmetastatic clear cell renal cell carcinoma (ccRCC) patients after treatment.

Methods: The retrospective study consisted of 985 patients with ccRCC who had undergone nephrectomy from 2005 to 2010 at multiple centers. The patients were divided into four groups using a quartile of LMR or CRP, and their associations with clinical characteristics and outcome were systematically estimated.

Results: Both low LMR and high CRP significantly diminished overall survival (OS) and metastasis-free survival (MFS) in patients with ccRCC. Further investigation indicated that LMR and CRP were independent prognostic factors of both OS and MFS. Integration of LMR and CRP into a predictive model, including significant variables in multivariate analysis, established a nomogram to predict accurately the 3- and 5-year survival for nonmetastatic patients with ccRCC.

Conclusion: LMR and CRP represent independent prognostic factors of OS and MFS for patients with ccRCC. Incorporation of LMR and CRP into the traditional TNM staging system may improve their predictive performance.

Keywords: C-reactive protein; clear cell renal cell carcinoma; lymphocyte-to-monocyte ratio; nomogram; survival.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for overall survival (A and B) and metastasis-free survival (C and D) of patients with nonmetastatic clear cell renal cell carcinoma according to LMR (A and C) and CRP (B and D). Abbreviations: CRP, C-reactive protein; LMR, lymphocyte-to-monocyte ratio; Q, quartile.
Figure 1
Figure 1
Kaplan–Meier curves for overall survival (A and B) and metastasis-free survival (C and D) of patients with nonmetastatic clear cell renal cell carcinoma according to LMR (A and C) and CRP (B and D). Abbreviations: CRP, C-reactive protein; LMR, lymphocyte-to-monocyte ratio; Q, quartile.
Figure 2
Figure 2
Nomogram for predicting 3- and 5-year overall survival (A) and metastasis-free survival (B) of patients with nonmetastatic clear cell renal cell carcinoma. Abbreviations: CRP, C-reactive protein; LMR, lymphocyte-to-monocyte ratio.
Figure 3
Figure 3
Calibration plot of the nomogram for 5-year OS (A) and MFS (B). Notes: The solid line shows the performance of the observed nomogram. The gray dashed line indicates the performance of an ideal nomogram. X axis is the bootstrapped corrected evaluation of nomogram with 1,000 resamples. Vertical bars represent 95% confidence interval. It seems that the nomograms accurately predict the 5-year OS (A) and MFS (B). (A) n=958; d=133; P=6; 150 subjects per group; X – resampling optimism added, B=1,000; comparison between nomogram-predicted probability of OS (x-axis) and the actual 5-year survival (y-axis). (B) n=958; d=188; P=5; 150 subjects per group; X – resampling optimism added, B=1,000; comparison between nomogram-predicted probability of MFS (x-axis) and the actual 5-year survival (y-axis). Abbreviations: MFS, metastasis-free survival; OS, overall survival.

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