Predictive Value Of Lymphocyte-to-monocyte Ratio And Serum Albumin In Patients With Clear Cell Renal Cell Carcinoma

Objective: Growing evidence indicates that inflammation plays an important role in the development and progression of tumors.Preoperative lymphocyte to monocyte ratio(LMR)and serum albumin has been estimated as an independent prognostic factor of various cancers.This study aimed to investigate the relationship between the ratio of lymphocyte to monocyte ratio(LMR)with serum albumin and the prognosis of patients with renal clear cell carcinoma(ccRCC).Methods: Data of 147 patients who underwent radical and partial nephrectomy between 2012 and 2015 were retrospectively studied at a single tertiary academic center.Preoperative LMR and serum albumin was calculated1 week before surgical intervention.Patients were categorized using an median value of LMR cutoff of 3.42.Dichotomization of serum albumin was according to the lower range of normal measurement at 40 g/L.The relationship between LMR amd serum albumin with other clinical factors and overall survival(OS)were analyzed using univariate analysis and COX regression model.LMR and serum albumin combined with TNM stage and Fuhrman grade to be analyzed,the influence of the LMR and serum albumin on the predictive accuracy using the Harrell concordance index(C-index).A nomogram,which predicted the 3-and 5-year survival rates for patients with ccRCC was established by incorporating LMR and serum albumin into a prognostic model with TNM stage and Fuhrman grades.Results: LMR and serum albumin were an independent prognostic factor in overall survival(OS)(P=0.001).Low LMR was statistically significantly associated with high Fuhrman grade(P=0.006)and the presence of tumor necrosis(P=0.039).Low serum albumin was significantly correlated with high Fuhrman grade(P < 0.001)and high SSIGN score(P=0.001).Multivariate analysis identified a low LMR and low serum albumin as an independent prognostic factor for patients' OS(HR=0.37;95%CI:0.145-0.942;P=0.037;HR=0.325;95%CI:0.136-0.775;P=0.011).The C-index rose when LMR and serum albumin was combined with TNM stage and Fuhrman grade.A nomogram,which predicted the 3-and 5-year survival rates for patients with ccRCC.Conclusions: Incorporating LMR and serum albumin into traditional clinicopathological analysis can improve the predictive value for patients with ccRCC after surgery intervention.