| Background and objectiveRenal cell carcinoma(RCC)is a kind of malignant tumor originating from epithelial tissue of uriniferous tubule,which is the most common malignant tumor of renal parenchyma in urinary system.RCC accounts for 2%-3%of all adult malignant tumors.There are about 5%individual who are diagnosed with RCC at the age younger than 40.Patients have a better prognosis if they have an early diagnosis and therapy.But once recurrence and metastases occur,it will have an unfavourable outcome.Some indicator such as TNM stage,nuclear grade,the histologic type is the primary indicator to predict the prognosis.Recently,age at receiving surgery and the pre-operation peripheral neutrophils-to-lymphocytes ratio(NLR)has been recognized as the prognostic factors in many studies.It is reported that patients will have a better prognosis at a younger age when received surgery and a low pre-operation peripheral NLR.But previous research revealed conflicting results about the prognostic significance of age in non-metastatic RCC,and in the present studies,there still lacks the specific age-group.Each study's cut-off point of NLR gained various values because of the different statistical method.Moreover,most of the relevant researches were focus on western population and there was little research which was based on data from Chinese populations.Therefore,the aim of our study was to identify the relationship between the age or NLR and the outcomes of a large cohort of Chinese RCC patients.MethodsThe medical records of 1022 consecutive patients who underwent radical or partial nephrectomy in our hospital from 2011 to 2016 were evaluated retrospectively.The excluding standards are as follows:(a)patients who were diagnosed with the von Hippel-Lindau disease preoperatively;(b)patients with distant metastasis;(c)pathology type is not explicitly confirmed as the RCC;(d)patients who receive the adjuvant therapy postoperatively;(e)no data on follow-up.ROC(receiver operating characteristics)curve was used to determine the cut off value of neutrophils-to-lymphocytes ratio.A chi-square test was used to compare qualitative variables and quantitative variables were analyzed by a Student t test.The survival analysis was analyzed by Kaplan-Meier method,and the differences were determined by log-rank test.Multivariate Cox regression models were applied to evaluate the independent prognostic significance of age and NLR.P<0.05 was considered significant.ResultsIn the three age group,only T stage were found to be associated with age.Sex ratio,symptoms at diagnosis,tumor size,T and N stage were significant associated with NLR level.Kaplan-Meier survival curve showed that age,NLR level,symptoms at diagnosis,operation methods,tumor size,T and N stage were all strongly associated with OS.Multivariate analysis revealed that age at surgery,symptoms at diagnosis(HR 2.5,95%CI 1.45-4.33,P=0.001),operation method(HR 5.16,95%CI 1.22-21.77,P=0.025),tumor size(HR 2.5,95%CI 1.45-4.31,P=0.001)9 T stage(HR 2.45,95%CI 1.16-5.14,P=0.018),histological subtype(HR 2.65,95%CI 1.45-4.82,P=0.001)and NLR(HR 1.97,95%CI 1.10-3.53,P=0.022)were independent predictors of OS.ConclusionThis study suggest that overall survival is high in patients with NLR<=2.19 and younger than 60-yr.Age and NLR are independent prognostic factors for patients with non-metastatic RCC receiving surgery. |
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