Platelet-Lymphocyte Ratio: a Potential Predictor for Late Recurrence of Renal Cell Carcinoma

Abstract

INTRODUCTION Controversy exists on the optimal duration of follow-up after renal cell carcinoma (RCC) treatment. While some authors argue that follow-up with imaging is not cost-effective after five years, approximately 10-20% of recurrences in patients treated with nephrectomy for RCC develop beyond 5 yr after surgery (late recurrence). This study aimed to evaluate Platelet-Lymphocyte Ratio (PLR) as a potential predictor for late recurrence of RCC in patients with localized disease treated surgically. METHODS A retrospective study at a tertiary center was conducted, including 140 patients with clinically localized (N0M0), clear cell RCC, who underwent radical/partial nephrectomy between 2005-2012, without disease recurrence in the first 60 months of follow-up. RESULTS A total of 140 patients (67 % males) with a median age of 58 years, were followed for a median of 134 months. Thirteen (9.3 %) had late disease recurrence with a median recurrence time of 119 months. Most patients had pT1a (n=75, 53.6%) and pT1b (n=37, 26.4%) stage. In univariate analysis, tumour size (HR 1.267 p=0.008), nuclear grade (G3-4) (HR 4.199, p=0.017), more advanced local T-stage (≥T2) (HR 7.613, p=0.001), necrosis (HR 5.040, p=0.004), lymphovascular invasion (HR 3.558, p=0.026) and higher PLR (HR 1.006, p=0.014) were associated with late recurrence (table 1). Patients with PLR greater than 150 had higher change of late recurrence (HR 3.548, p=0.023). After adjusting for other variables, PLR remained a significant independent predictor of late recurrence (HR 1.010, p=0.023). A PLR value higher than 150 had a cox-adjusted HR of 4.200, p=0.032. CONCLUSIONS As far as we know, this was the first study to report PLR as an independent predictor for late recurrence of RCC, with potential clinical utility. In agreement to previous reports, in our study, local staging, histological grade, tumour necrosis and lymphovascular invasion were also prognostic factors for late recurrence of RCC, after surgical treatment.