Platelet-to-lymphocyte Ratio (PLR) as an Indicator of Survival in Rare Histopathological Subtypes of Renal Cell Carcinoma

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Emrah Eraslan
Mutlu Doğan


Objective: Inflammatory markers have prognostic significance for renal cell carcinomas (RCC) as in many types of cancer. The prognostic effect of inflammatory markers in the rare histological subtypes of RCC has not been adequately evaluated. In our study, we aimed to evaluate the relationship between basal inflammatory indices (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], lymphocyte to monocyte ratio [LMR], and systemic immune-inflammation [SII]) and survival (progression-free survival [PFS] and overall survival [OS]).

Material and Methods: Patients with metastatic non-clear cell RCC (nccRCC) or RCC with sarcomatoid differentiation (sRCC) were included in the study. The relationship between inflammatory indices, which was calculated before any systemic treatment and survival, were retrospectively assessed.

Results: Thirty patients, predominantly males (n = 20, 66.7%), with a median age of 59.1 (IQR, 52.5-70.3) years, were included in the study. Median PFS achieved with first-line tyrosine kinase inhibitors for patients with a PLR level less or greater than the median value (238) was 12.6 (95% CI 1.4-23.9) months and 4.8 (95% CI, 2.3-7.3) months, respectively (p = 0.021). Median OS for patients with a PLR level less or greater than the median (238) was 16.7 (95% CI, 3.7-29.7) months and 8.6 (95% CI, 4.9-12.3) months (p = 0.008), respectively. In the Cox-regression model (including gender, age, presence of metastasis at diagnosis, NLR, PLR, LMR, SII) only PLR was the independent predictive factor for both PSF (HR = 0.131; 95% Cl 0.028-0.620, p = 0.010) and OS (HR = 0.199; 95% Cl 0.048-0.819, p = 0.025).


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Eraslan, E., & Doğan, M. (2021). Platelet-to-lymphocyte Ratio (PLR) as an Indicator of Survival in Rare Histopathological Subtypes of Renal Cell Carcinoma. Medical Science and Discovery, 8(4), 283-288.
Research Article


1. SEER Cancer Stat Facts: Kidney and Renal Pelvis Cancer: Bethesda MD: National Cancer Institute; 2020 [Available from: Last accessed 30 March 2021]

2. Moch H, Gasser T, Amin MB, Torhorst J, Sauter G, Mihatsch MJ. Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumours. Cancer. 2000;89(3):604-14.

3. Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, Blute ML, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol. 2010;183(4):1309-15.

4. Farrow GM, Harrison Jr EG, Utz DC. Sarcomas and sarcomatoid and mixed malignant tumours of the kidney in adults—part III. Cancer. 1968;22(3):556-63.

5. de Peralta-Venturina M, Moch H, Amin M, Tamboli P, Hailemariam S, Mihatsch M, et al. Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol. 2001;25(3):275-84.

6. Cheville JC, Lohse CM, Zincke H, Weaver AL, Leibovich BC, Frank I, et al. Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol. 2004;28(4):435-41.

7. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44.

8. Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15(11):e493-503.

9. Kim J, Park JS, Heo JE, Elghiaty A, Jang WS, Rha KH, et al. Neutrophil-to-Lymphocyte Ratio Predicts Pathological Renal Sinus Fat Invasion in Renal Cell Carcinomas of ≤7 cm with Presumed Renal Sinus Fat Invasion. Yonsei Med J. 2019;60(11):1021-7.

10. Gu L, Li H, Chen L, Ma X, Li X, Gao Y, et al. Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis. Oncotarget. 2016;7(22):31926-42.

11. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22.

12. Szebeni GJ, Vizler C, Kitajka K, Puskas LG. Inflammation and Cancer: Extra- and Intracellular Determinants of Tumour-Associated Macrophages as Tumour Promoters. Mediators Inflamm. 2017;2017:9294018.

13. Dong M, Shi Y, Yang J, Zhou Q, Lian Y, Wang D, et al. Prognostic and clinicopathological significance of systemic immune-inflammation index in colorectal cancer: a meta-analysis. Ther Adv Med Oncol. 2020;12:1758835920937425.

14. Barua SK, Singh Y, Baruah SJ, T PR, Bagchi PK, Sarma D, et al. Predictors of Progression-Free Survival and Overall Survival in Metastatic Non-Clear Cell Renal Cell Carcinoma: A Single-Center Experience. World J Oncol. 2019;10(2):101-11.

15. Zhang Z, Yu Y, Zheng J, Zhang M, Niu H. Prognostic significance of preoperative neutrophil-to-lymphocyte ratio in papillary renal cell carcinoma patients after receiving curative surgery based on a retrospective cohort. BMC Urol. 2021;21(1):43.

16. Klatte T, Rossi SH, Stewart GD. Prognostic factors and prognostic models for renal cell carcinoma: a literature review. World J Urol. 2018;36(12):1943-52.

17. Zheng W, Zhu W, Yu S, Li K, Ding Y, Wu Q, et al. Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma. BMC Cancer. 2020;20(1):1066.

18. Linehan WM, Spellman PT, Ricketts CJ, Creighton CJ, Fei SS, Davis C, et al. Comprehensive Molecular Characterization of Papillary Renal-Cell Carcinoma. N Engl J Med. 2016;374(2):135-45.

19. Ohashi R, Angori S, Batavia AA, Rupp NJ, Ajioka Y, Schraml P, et al. Loss of CDKN1A mRNA and Protein Expression Are Independent Predictors of Poor Outcome in Chromophobe Renal Cell Carcinoma Patients. Cancers (Basel). 2020;12(2).

20. Bakouny Z, Braun DA, Shukla SA, Pan W, Gao X, Hou Y, et al. Integrative molecular characterization of sarcomatoid and rhabdoid renal cell carcinoma (S/R RCC) to reveal potential determinants of poor prognosis and response to immune checkpoint inhibitors (ICI). Journal of Clinical Oncology. 2020;38(6_suppl):715-.

21. Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(34):5794-9.

22. Gu L, Li H, Gao Y, Ma X, Chen L, Li X, et al. The association of platelet count with clinicopathological significance and prognosis in renal cell carcinoma: a systematic review and meta-analysis. PLoS One. 2015;10(5):e0125538.

23. Saroha S, Uzzo RG, Plimack ER, Ruth K, Al-Saleem T. Lymphopenia is an independent predictor of inferior outcome in clear cell renal carcinoma. J Urol. 2013;189(2):454-61.

24. Gunduz S, Mutlu H, Tural D, Yıldız Ö, Uysal M, Coskun HS, et al. Platelet to lymphocyte ratio as a new prognostic for patients with metastatic renal cell cancer. Asia Pac J Clin Oncol. 2015;11(4):288-92.

25. Wang Z, Peng S, Wang A, Xie H, Guo L, Jiang N, et al. Platelet-lymphocyte ratio acts as an independent predictor of prognosis in patients with renal cell carcinoma. Clin Chim Acta. 2018;480:166-72.

26. Bugdayci Basal F, Karacin C, Bilgetekin I, Oksuzoglu OB. Can Systemic Immune-Inflammation Index Create a New Perspective for the IMDC Scoring System in Patients with Metastatic Renal Cell Carcinoma? Urol Int. 2021:1-8.

27. Ozbek E, Besiroglu H, Ozer K, Horsanali MO, Gorgel SN. Systemic immune inflammation index is a promising non-invasive marker for the prognosis of the patients with localized renal cell carcinoma. Int Urol Nephrol. 2020;52(8):1455-63.

28. Nunno VD, Mollica V, Gatto L, Santoni M, Cosmai L, Porta C, et al. Prognostic impact of neutrophil-to-lymphocyte ratio in renal cell carcinoma: a systematic review and meta-analysis. Immunotherapy. 2019;11(7):631-43.

29. Tu X, Wang F, Chang T, Zhang C, Zhang M, Liu Z, et al. Predictive value of preoperative neutrophil-to-lymphocyte ratio in non-metastatic papillary renal cell carcinoma patients after receiving curative surgery. Cancer Manag Res. 2019;11:7515-24.

30. de Martino M, Pantuck AJ, Hofbauer S, Waldert M, Shariat SF, Belldegrun AS, et al. Prognostic impact of preoperative neutrophil-to-lymphocyte ratio in localized non-clear cell renal cell carcinoma. J Urol. 2013;190(6):1999-2004.

31. Buti S, Bersanelli M, Maines F, Facchini G, Gelsomino F, Zustovich F, et al. First-Line PAzopanib in NOn-clear-cell Renal cArcinoMA: The Italian Retrospective Multicenter PANORAMA Study. Clin Genitourin Cancer. 2017;15(4):e609-e14.

32. Keizman D, Sarid D, Lee JL, Sella A, Gottfried M, Hammers H, et al. Outcome of Patients With Metastatic Chromophobe Renal Cell Carcinoma Treated With Sunitinib. Oncologist. 2016;21(10):1212-7.

33. Guo S, He X, Chen Q, Yang G, Yao K, Dong P, et al. The C-reactive protein/albumin ratio, a validated prognostic score, predicts outcome of surgical renal cell carcinoma patients. BMC Cancer. 2017;17(1):171