Prognostic value of lymphocyte-to-monocyte ratio previously determined to surgery in patients with non-metastatic renal cell carcinoma: A systematic review and a prisma-compliant meta-analysis

Dario Garcia-Rojo, Angel Prera, Jesus Muñoz-Rodriguez, Joan Carles Oliva, Arturo Dominguez, Joan Prats, Dario Garcia-Rojo, Angel Prera, Jesus Muñoz-Rodriguez, Joan Carles Oliva, Arturo Dominguez, Joan Prats

Abstract

Background: The prognostic value of pretreatment lymphocyte to monocyte ratio in patients with renal cell carcinoma and, especially, in non-metastatic patients remains controversial.

Methods: We conducted a PRISMA-compliant meta-analysis to systematically assess the prognostic value of LMR in patients with non-metastatic RCC. Overall survival, cancer-specific survival, and disease-free survival were analyzed. Pooled hazard ratios and 95% confidence intervals were calculated.

Results: Seven studies comprising 4666 patients were included in the analysis. Unlike those observed in a previous meta-analysis, a lower lymphocyte to monocyte ratio was associated with poorer cancer-specific survival (fix-effect model, hazard ratio 3.04, 95% confidence intervals 2.05-4.51, P < .05). Heterogeneity Chi-squared value Q exp = 0. (P = .82) (I2 = 0%). However, the association between a low lymphocyte to monocyte ratio and overall survival or disease-free survival did not obtain significance.

Conclusion: A lower lymphocyte to monocyte ratio implied poor cancer-specific survival in patients with non-metastatic renal cell carcinoma. Prospective studies are required to confirm our findings.

Registration number: ClinicalTrials.gov (identifier: NCT04213664).

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the systematic literature search. (PRISMA, preferred reporting items for systematic reviews and meta-analysis).
Figure 2
Figure 2
The forest plot of the relationship between the LMR and OS, CSS, and DFS in non-metastatic renal cell carcinoma. [CSS = cancer-specific survival, DFS = disease-free survival, LMR = lymphocyte-to-monocyte ratio, OS = overall survival].
Figure 3
Figure 3
The funnel plot of the Begg test for the publication bias assessment of the synthesized HR assessing the prognostic value of pretreatment LMR for CSS in non-metastatic renal cell cancer. [CSS = Cancer-specific survival, HR = Hazard ratio, LMR = lymphocyte-to-monocyte ratio].

References

    1. European Association of Urology. Guidelines. Renal cell carcinoma.2019 update (Accessed July 31, 2020). Available at: .
    1. Grimes N, Tyson M, Hannan C, et al. A systematic review of the prognostic role of hematologic scoring systems in patients with renal cell carcinoma undergoing nephrectomy with curative intent. Clin Genitourin Cancer 2016;14:271–6.
    1. Wang X, Su S, Guo Y. The clinical use of the platelet to lymphocyte ratio and lymphocyte to monocyte ratio as prognostic factors in renal cell carcinoma: a systematic review and meta-analysis. Oncotarget 2017;8:84506–14.
    1. Li J, Cheng Y, Ji Z. Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with urologic tumors: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019;98:e14091.
    1. Hutterer GC, Stoeckigt C, Stojakovic T, et al. Low preoperative lymphocyte-monocyte ratio (LMR) represents a potentially poor prognostic factor in nonmetastatic clear cell renal cell carcinoma. Urologic oncology: seminars and original investigations 2014;32:1041–8.
    1. Lucca I, de Martino M, Hofbauer SL, et al. Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma. World J Urol 2015;33:2045–52.
    1. Chang Y, Fu Q, Xu L, et al. Prognostic value of preoperative lymphocyte to monocyte ratio in patients with nonmetastatic clear cell renal cell carcinoma. Tumour Biol 2016;37:4613–20.
    1. Xia WK, Wu X, Yu TH, et al. Prognostic significance of lymphocyte-to-monocyte ratio and CRP in patients with nonmetastatic clear cell renal cell carcinoma: a retrospective multicenter analysis. Onco Targets Ther 2016;9:2759–67.
    1. Chen Z, Shao Y, Yao H, et al. Preoperative albumin to globulin ratio predicts survival in clear cell renal cell carcinoma patients. Oncotarget 2017;8:48291–302.
    1. Elghiaty A, Kim J, Jang WS, et al. Predictive value of preoperative monocyte-lymphocyte ratio among patients with localized clear renal cell carcinoma of ≤7cm on preoperative imaging. Medicine (Baltimore) 2018;97:e13433.
    1. Chen Z, Wang K, Lu H, et al. Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis. Cancer Manag Res 2019;11:909–19.
    1. Li M, Deng Q, Zhang L, et al. The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with urological cancers: a meta-analysis. Pathol Res Pract 2019;215:5–11.
    1. Lucarelli G, Loizzo D, Franzin R, et al. Metabolomic insights into pathophysiological mechanisms and biomarker discovery in clear cell renal cell carcinoma. Expert Rev Mol Diagn 2019;19:397–407.
    1. Bianchi C, Meregalli C, Bombelli S, et al. The glucose and lipid metabolism reprogramming is grade-dependent in clear cell renal cell carcinoma primary cultures and is targetable to modulate cell viability and proliferation. Oncotarget 2017;8:113502–15.
    1. Lucarelli G, Rutigliano M, Sallustio F, et al. Integrated multi-omics characterization reveals a distinctive metabolic signature and the role of NDUFA4L2 in promoting angiogenesis, chemoresistance, and mitochondrial dysfunction in clear cell renal cell carcinoma. Aging (Albany NY) 2018;10:3957–85.
    1. Lucarelli G, Monica Rutigliano M, Ferro M, et al. Activation of the kynurenine pathway predicts poor outcome in patients with clear cell renal cell carcinoma. Urol Oncol 2017;35:461e15–27.
    1. Papale M, Vocino G, Lucarelli G, et al. Urinary RKIP/p-RKIP is a potential diagnostic and prognostic marker of clear cell renal cell carcinoma. Oncotarget 2017;8:40412–24.
    1. Netti GS, Lucarelli G, Spadaccino F, et al. PTX3 modulates the immunoflogosis in tumor microenvironment and is a prognostic factor for patients with clear cell renal cell carcinoma. Aging (Albany NY) 2020;12:7585–602.
    1. Lucarelli G, Rutigliano M, Sanguedolce F, et al. Increased expression of the autocrine motility factor is associated with poor prognosis in patients with clear cell-renal cell carcinoma. Medicine (Baltimore) 2015;94:e2117.
    1. Gigante M, Lucarelli G, Chiara Divella Ch, et al. Soluble serum αKlotho is a potential predictive marker of disease progression in clear cell renal cell carcinoma. Medicine (Baltimore) 2015;94:e1917.
    1. Lucarelli G, Ditonno P, Bettocchi C, et al. Diagnostic and prognostic role of preoperative circulating CA 15-3, CA 125, and beta-2 microglobulin in renal cell carcinoma. Dis Markers 2014;2014:689795.
    1. Zhu G, Pei L, Yin H, et al. Profiles of tumor-infiltrating immune cells in renal cell carcinoma and their clinical implications. Oncol Lett 2019;18:5235–42.
    1. Nakano O, Sato M, Naito Y, et al. Proliferative activity of intratumoral CD8(+) T-lymphocytes as a prognostic factor in human renal cell carcinoma: clinicopathologic demonstration of antitumor immunity. Cancer Res 2001;61:5132–6.

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