The Role Of NLR, PLR And AGR As Prognostic Indicators In Renal Cell Carcinoma

Objective: Our aim is to investigate the prognostic significance of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and albumin to globin ratio(AGR)in renal clear cell carcinoma by analyzing the information of 103 patients who were treated in the Oncology Department of the First Hospital of Jilin University from January 2005 to December 2018.Methods: A total of 103 patients with renal clear cell carcinoma diagnosed in the Oncology Department of the First Hospital of Jilin University from January 2005 to December 2018 were included in our study.We retrospectively collect information of patients according to the inclusion and exclusion criteria.Gender,age of diagnosis,first symptoms,preoperative neutrophil count,lymphocyte count,platelet count,hemoglobin,albumin,globulin,tumor necrosis and TNM stage were recorded.We recorded patients' relapses,metastases,and survival time.Preoperative peripheral blood data is used to calculate the ratio of neutrophils to lymphocytes(NLR),platelet to lymphocytes(PLR),and albumin to globulin(AGR).We analyzed the relationship between NLR,PLR,AGR and other clinicopathological factors and then explore the significance of each factor on the prognosis of renal cell carcinoma.Results: 1.In the higher NLR group,tumor necrosis(P=0.003),lower hemoglobin concentration(P=0.004),lower albumin(P = 0.015),higher PLR(P<0.001)and male patients(P<0.001)occur more.Higher PLR is significantly associated with tumor necrosis(P=0.008),TNM stage III-IV(P=0.019),lower hemoglobin concentration(P<0.001),lower albumin level(P<0.001),higher globulin level(P=0.003),higher NLR(P<0.001)and lower AGR(P<0.001).Lower AGR is significantly associated with tumor necrosis(P=0.043),lower hemoglobin concentration(P<0.001),lower albumin level(P<0.001),higher platelet count(P<0.001)and higher PLR(P<0.001).2.In the univariate analysis,patients with higher hemoglobin concentration,lower globulin level,lower platelet count,higher AGR,lower NLR and PLR have longer median PFS(P<0.05).Patients with no tumor necrosis,TNM stage I-II,higher hemoglobin concentration,higher serum albumin level,lower globulin level,higher lymphocyte count,lower platelet count,higher AGR,lower NLR and PLR have longer median OS and better prognosis(P<0.05).3.In the subgroup univariate analysis,NLR is significantly associated with PFS in patients with non-metastatic RCC(P = 0.013).AGR has a significant effect on PFS in metastatic RCC(P=0.036).PLR has no statistical significance in PFS of both subgroups(P>0.05).NLR,PLR,and AGR are significantly associated with OS in patients with non-metastatic RCC(P=0.007,0.022,0.011,respectively),but have no statistical significance for metastatic RCC(P> 0.05).4.Multivariate analysis identifies several independent prognostic factors for PFS including platelet count(P=0.005)and AGR(P= 0.027)and for OS including NLR(P<0.001)?AGR(P<0.001)?TNM stage(P=0.006).PLR is not an independent prognostic factor for RFS and OS(P>0.05).Conclusions: 1.NLR,PLR and AGR are all significantly associated with tumor necrosis,hemoglobin and albumin.PLR is also associated with globulin and TNM stage,and AGR is also associated with platelets.2.In renal cell carcinoma,NLR and AGR are independent prognostic factors,PLR has no statistical significance.In addition,platelet count,TNM stage are also independent prognostic factors of RCC.Patients with higher NLR,lower AGR,higher platelet count,and poorer TNM stage at the time of diagnosis are prone to relapse and progression and have shorter survival time.We should pay close attention to changes of disease and promptly guide treatment.3.Compared with metastatic RCC,NLR,PLR,AGR have a greater correlation with the survival of patients with non-metastatic RCC.The detection of these three indicators especially NLR and AGR for non-metastatic RCC patients has more prognostic significance.